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QUESTION 1: Do balanced fluids have benefits over 0.9% sodium chloride?
  1. Ashish Patel,
  2. Sally-Ann Hulton
  1. Department of Paediatric Nephrology, Birmingham Woman’s and Children’s NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Dr Ashish Patel, Department of Paediatric Nephrology, Birmingham Woman’s and Children’s NHS Foundation Trust, Birmingham B15 2TG, UK; ashish.patel3{at}nhs.net

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Scenario

A 2-year-old girl presented with a history of fever, general lethargy and reduced intake. She was treated for presumed sepsis and given a fluid bolus of 20 mL/kg of 0.9% sodium chloride due to tachycardia and low urine output. A metabolic acidosis was noted on the capillary gas with low bicarbonate levels. She was commenced on maintenance intravenous fluids of 0.9% sodium chloride with 5% glucose. A question arose as to whether this was the most suitable fluid choice.

Structured clinical question

In children (patient), is there any benefit (outcome) of using balanced fluids (intervention) over 0.9% sodium chloride (comparison) as intravenous fluid therapy?

Searches

In secondary sources on Cochrane, searches for ‘Plasma-Lyte OR balanced fluids vs saline OR 0.9% sodium chloride’. Nil results were found in the paediatric population, but one multicentre randomised controlled trial in adults.

A search of MEDLINE (1946–2018) was performed using the search strings (child OR infant OR paediatric OR pediatric OR adolescent) AND (Plasma-Lyte OR balanced solution OR balanced fluids OR Ringer’s Lactate OR Hartmann’s) AND (saline OR sodium chloride OR 0.9% saline OR 0.9% sodium chloride) AND (benefit OR advantage OR better). The search was limited to English articles only and 376 articles were identified of which four seemed relevant and reviewed in depth.

Discussion

When deciding on intravenous fluid therapy in children, the National Institute for Health and Care Excellence recommends using any isotonic crystalloid containing sodium in …

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