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Global child health
Fluid and electrolyte pathophysiology in common febrile illness in children and the implications for clinical management
  1. Clare Ruth Smith1,
  2. Poh Chua2,
  3. Catherine Papaioannou1,
  4. Ranjana Warrier1,
  5. Gregory J G Nolan1,
  6. Yu-Feng Frank Hsiao3,
  7. Trevor Duke1,4,5
  1. 1 Paediatric Intensive Care Unit, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
  2. 2 Library, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
  3. 3 Anaesthesia, Monash Health, Clayton, Victoria, Australia
  4. 4 Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
  5. 5 Child health, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
  1. Correspondence to Prof Trevor Duke; trevor.duke{at}rch.org.au

Abstract

Achieving fluid homeostasis and the management of fluid and electrolyte complications are constants in the treatment of seriously ill children worldwide. Consensus on the most appropriate fluid strategy for unwell children has been difficult to achieve and has evolved over the last two decades, most notably in high-income countries where adverse events relating to poor fluid management were identified more readily, and official robust inquiries were possible. However, this has not been the situation in many low-income settings where fluids that are prohibited from use in high-income countries may be all that are available, local guidelines and processes to recognise adverse events are not developed, and there has been limited training on safe fluid management for front-line healthcare workers. This narrative review outlines the fluid and electrolyte pathophysiology of common febrile illnesses in children, describes the evolution of this field and concludes with implications and principles of a fluid management strategy for seriously ill children. This review was prepared as a physiological background paper to support evidence presented to the WHO Guideline Development Group for Fluid Guidelines in Children, Geneva, March 2024.

  • Paediatrics
  • Physiology
  • Global Health

https://doi.org/10.1136/archdischild-2024-327407

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    Footnotes

    • Contributors All authors designed the review. PC designed and carried out the systematic searches. TD, CRS, CP, RW, GJGN and Y-FFH reviewed the evidence and drafted summaries. TD and CRS wrote the initial draft of the manuscript and subsequent versions, and all authors reviewed the final version. RW constructed the figure. TD is the guarantor for the study.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests TD was co-chair of the WHO Guideline Development Group on Fluid Management in Children, 2022–2024.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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      Archives of Disease in Childhood 2024; 109 i-i Published Online First: 25 Sep 2024. doi: 10.1136/archdischild-2024-327949