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Question 2: Should 0.9% saline be used for maintenance fluids in hospitalised children?
  1. Jessie Anne Morgan
  1. Correspondence to Dr Jessie Anne Morgan, Calderdale Royal Hospital, Salterhebble, Halifax, West Yorkshire HX3 0PW, UK; jessie.morgan{at}

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A 6-year-old boy with severe tonsillitis requires intravenous maintenance fluids. As a new specialist registrar to this hospital you are unfamiliar with their fluid policy. The nurse informs you that the routine intravenous solution used is 0.45% sodium chloride with 5% dextrose. This is not what you are familiar with having previously used 0.9% sodium chloride with 5% dextrose. You are unsure what the evidence for isotonic versus hypotonic fluid is in children requiring intravenous maintenance fluids, in particular the effect on serum sodium.

Structured clinical question

In hospitalised children requiring intravenous maintenance fluids (population), do isotonic solutions (intervention) compared with hypotonic solutions (comparison) reduce the risk of hyponatraemia (outcome)?

Search strategy and outcome

Medline (1996 to week 2 of 2015), Embase (1996 to week 11 of 2015) and Cochrane Library (searches completed on 16 March 2015). Used terms (child* or infan* or adolescen* or young adj person or young adj people, MeSH terms children/adolescent/child, pre-school/infant) AND (fluid adj3 therapy or (fluid therapy/)) AND (isoton* or Isotonic solutions/or sodium adj chloride or sodium chloride/) AND (hyponton* or hypotonic solutions/or sodium adj chloride or sodium chloride/) AND (hyponatr?emia or sodium …

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  • Contributors JAM—Carried out the search strategy, reviewed the literature and wrote the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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