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Fluid therapy for children: facts, fashions and questions
  1. Malcolm A Holliday1,
  2. Patricio E Ray2,
  3. Aaron L Friedman3
  1. 1Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
  2. 2George Washington University Medical Center, Children’s Research Institute, Children’s National Medical Center, Washington, DC, USA
  3. 3Department of Pediatrics, Brown Medical School, Hasbro Children’s Hospital, Providence, RI, USA
  1. Correspondence to:
    Dr Malcolm A Holliday
    Department of Pediatrics, University of California, San Francisco, San Francisco, CA 94143, USA; malcolm.holliday{at}


Fluid therapy restores circulation by expanding extracellular fluid. However, a dispute has arisen regarding the nature of intravenous therapy for acutely ill children following the development of acute hyponatraemia from overuse of hypotonic saline.

The foundation on which correct maintenance fluid therapy is built is examined and the difference between maintenance fluid therapy and restoration or replenishment fluid therapy for reduction in extracellular fluid volume is delineated. Changing practices and the basic physiology of extracellular fluid are discussed. Some propose changing the definition of “maintenance therapy” and recommend isotonic saline be used as maintenance and restoration therapy in undefined amounts leading to excess intravenous sodium chloride intake.

Intravenous fluid therapy for children with volume depletion should first restore extracellular volume with measured infusions of isotonic saline followed by defined, appropriate maintenance therapy to replace physiological losses according to principles established 50 years ago.

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  • Published Online First 15 December 2006

  • Competing interests: None.

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    BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health