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.