PT  - JOURNAL ARTICLE
AU  - Neville, K A
AU  - Verge, C F
AU  - Rosenberg, A R
AU  - O’Meara, M W
AU  - Walker, J L
TI  - Isotonic is better than hypotonic saline for intravenous rehydration of children with gastroenteritis: a prospective randomised study
AID  - 10.1136/adc.2005.084103
DP  - 2006 Mar 01
TA  - Archives of Disease in Childhood
PG  - 226--232
VI  - 91
IP  - 3
4099  - http://adc.bmj.com/content/91/3/226.short
4100  - http://adc.bmj.com/content/91/3/226.full
SO  - Arch Dis Child2006 Mar 01; 91
AB  - Aims: To determine whether the risk of hyponatraemia in children with gastroenteritis receiving intravenous (IV) fluids is decreased by the use of 0.9% saline. Methods: A prospective randomised study was carried out in a tertiary paediatric hospital. A total of 102 children with gastroenteritis were randomised to receive either 0.9% saline + 2.5% dextrose (NS) or 0.45% saline + 2.5% dextrose (N/2) at a rate determined by their treating physician according to hospital guidelines and clinical judgement. Plasma electrolytes, osmolality, and plasma glucose were measured before (T0) and 4 hours after (T4) starting IV fluids, and subsequently if clinically indicated. Electrolytes and osmolality were measured in urine samples. Results were analysed according to whether children were hyponatraemic (plasma sodium <135 mmol/l) or normonatraemic at T0. Results: At T0, mean (SD) plasma sodium was 135 (3.3) mmol/l (range 124–142), with 37/102 (36%) hyponatraemic. At T4, mean plasma sodium in children receiving N/2 remained unchanged in those initially hyponatraemic (n = 16), but fell 2.3 (2.2) mmol/l in the normonatraemic group. In contrast, among children receiving NS, mean plasma sodium was 2.4 (2.0) mmol/l higher in those hyponatraemic at baseline (n = 21) and unchanged in the initially normonatraemic children. In 16 children who were still receiving IV fluids at 24 hours, 3/8 receiving N/2 were hyponatraemic compared with 0/8 receiving NS. No child became hypernatraemic. Conclusions: In gastroenteritis treated with intravenous fluids, normal saline is preferable to hypotonic saline because it protects against hyponatraemia without causing hypernatraemia.