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Question 3 Should isotonic infusion solutions routinely be used in hospitalised paediatric patients?
  1. AH Robroch,
  2. M van Heerde,
  3. DG Markhorst
  1. Pediatric Intensive Care Unit, Free University Medical Center, Amsterdam, The Netherlands

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Scenario

A 6-year-old boy weighing 23 kg is repatriated to your unit from a Dutch hospital after appendectomy complicating a short holiday trip abroad. He is still on parenteral hydration. You notice that the prescribed intravenous solution of 1600 ml a day is hypotonic: dextrose 5%, NaCl 0.45% with 2 mmol potassium/kg/day added. His serum electrolytes and glucose are within the normal range. You wonder why your colleagues abroad did not prescribe isotonic maintenance solution so you decide to contact them. You are informed by the referral hospital that it is common practice to prescribe hypotonic fluids as maintenance solution, and you wonder whether your routine of prescribing isotonic fluids as maintenance is be preferred.

Structured clinical question

In hospitalised children needing intravenous maintenance fluids [patient], do hypotonic infusion solutions [intervention] lead to hyponatremia [outcome] compared to isotonic solutions [control]?

Search strategy and outcome

Embase and Medline via PubMed were the primary sources of articles. Search terms were: (hypotonic solution OR isotonic solution OR sodium chloride OR normal saline OR hypotonic saline OR isotonic saline OR hypotonic fluid OR isotonic fluid) AND (intravenous) NOT (oral OR enteral) AND hyponatremia. Limits were 0–18 years. …

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