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Hyponatraemia and hypokalaemia during intravenous fluid administration
  1. K Armon1,
  2. A Riordan2,
  3. S Playfor3,
  4. G Millman4,
  5. A Khader5,
  6. for the Paediatric Research Society
  1. 1
    Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, UK
  2. 2
    Paediatric Infectious Diseases and Immunology, Royal Liverpool Children’s Hospital (Alder Hey), Liverpool, UK
  3. 3
    Paediatric Intensive Care Medicine, Royal Manchester Children’s Hospital, Manchester, UK
  4. 4
    Pediatrics, York Hospital, York, UK
  5. 5
    Paediatrics, Addenbrooke’s Hospital, Cambridge, UK
  1. Kate Armon, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, Norfolk NR4 7UY, UK; kate.armon{at}


Background: Hospital-acquired hyponatraemia is associated with excessive volumes of hypotonic intravenous fluids and can cause death or permanent neurological deficit.

Methods: A cross-sectional survey was carried out in 17 hospitals on all children receiving intravenous fluids during 1 day of a specified week in December 2004.

Results: 77 of 99 children receiving intravenous fluids received hypotonic solutions and 38% received >105% of fluid requirements. 21 of 86 children were hyponatraemic, but the electrolytes of only 79% had been checked in the preceding 48 h.

Conclusions: Intravenous fluids should be used with caution as regards the tonicity and volume administered, and with appropriate monitoring of serum electrolytes.

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  • Funding: None.

  • Competing interests: None.

  • Ethics approval: None required.

  • Contributors: Kate Armon, Andrew Riordan and Stephen Playfor were involved in the concept, planning and design of the study. They all contributed data and were involved in data analysis. All took part in the drafting and editing of the final manuscript and will act as guarantors of the paper. Guy Millman was involved in the concept, planning and design of the study and collected data. Abdul Khader collected local data, collated and entered data from contributing centres and performed an initial analysis.

    Dr Ben Ramadan was involved in the initial concept and data collection.

    The following contributed patient data: Dr Mansoor Ahmed, Queen’s Hospital, Burton upon Trent, Staffordshire; Dr David Barker, Consultant, St Mary’s Hospital, Portsmouth; Dr Aoife Canney, SHO, University College Hospital, Galway, Ireland; Dr Ella Chakrapani, SpR, GlanClwyd Hospital, Rhyl, Denbighshire; Dr Mike Cosgrove, Consultant, Singleton Hospital, Swansea; Dr Abubaker Elbadri, Consultant, Whiston Hospital, Merseyside; Dr Louise Forshaw, SHO, Ormskirk Hospital, Lancashire; Dr Julie Jennings, SpR, Wigan Hospital, Wigan; Dr Angela Kelly, SHO, Arrow Park Hospital, Wirral; Dr Abdul Khader, SpR, Norfolk and Norwich University Hospital, Norwich; Dr Susan Leech, Consultant, King’s College Hospital, London; Dr Louise Munnisett, Consultant, GlanClwyd Hospital, Rhyl, Denbighshire; Dr Oliver Rackham, SpR, Countess of Chester Hospital, Chester; and Dr Kate Skone, PRHO, Birmingham Heartlands Hospital, Birmingham.