Skip to main content

Advertisement

Log in

Intravenous fluid regimen and hyponatraemia among children: a randomized controlled trial

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

The aim of this study was to compare the effect of three different intravenous (i.v.) fluid regimes on the incidence of hyponatraemia in hospitalized children ranging in age from 3 months to 12 years. Children who required the administration of i.v. maintenance fluid for at least 24 h following hospitalization were eligible for inclusion. The children were randomized to three i.v. fluid groups: Group A, 0.9% saline in 5% dextrose at the standard maintenance rate; Group B, 0.18% saline in 5% dextrose at the standard maintenance rate; Group C, 0.18% saline in 5% dextrose at two-thirds of the standard maintenance rate. The primary outcome measure was incidence of hyponatraemia (plasma sodium < 130 mEq/L). Of the 167 patients enrolled, 58, 56 and 53 patients were randomized to Group A, B and C, respectively. We observed that 14.3% (8/56) of the children administered 0.18% saline in 5% dextrose at the standard maintenance rate (Group B) developed hyponatraemia compared with 1.72% of the children in Group A and 3.8% of those in Group C. Based on these results, we conclude that the administration of 0.9% saline in 5% dextrose as i.v. maintenance fluid helps in reducing the incidence of hospital-acquired hyponatraemia among children.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Hoorn EJ, Geary D, Robb M, Halperin ML, Bohn D (2004) Acute hyponatraemia related to intravenous fluid administration in hospitalized children: an observational study. Pediatrics 113:1279–1284

    Article  PubMed  Google Scholar 

  2. Armon K, Riordan A, Playfor S, Millman G, Khader A, Society PR (2008) Hyponatraemia and hypokalaemia during intravenous fluid administration. Arch Dis Child 93:285–287

    Article  CAS  PubMed  Google Scholar 

  3. Neville K, Verge C, Rosenberg A, O'Meara M, Walker J (2006) Isotonic is better than hypotonic saline for intravenous rehydration of children with gastroenteritis: a prospective randomised study. Arch Dis Child 91:226–232

    Article  CAS  PubMed  Google Scholar 

  4. Brazel P, McPhee IP (1996) Inappropriate secretion of antidiuretic hormone in postoperative scoliosis patients: the role of fluid management. Spine 21:724–727

    Article  CAS  PubMed  Google Scholar 

  5. Wilkinson E, Rieff J, Rekate H, Beals S (1992) Fluid, blood, and blood product management in the craniofacial patient. Pediatr Neurosurg 18:48–52

    Article  CAS  PubMed  Google Scholar 

  6. Choong K, Kho M, Menon K, Bohn D (2006) Hypotonic versus isotonic saline in hospitalised children: a systematic review. Arch Dis Child 91:828–835

    Article  CAS  PubMed  Google Scholar 

  7. Holliday MA, Segar WE (1957) The maintenance need for water in parenteral fluid therapy. Pediatrics 19:823–832

    CAS  PubMed  Google Scholar 

  8. Gerigk M, Gnehm H, Rascher W (1996) Arginine vasopressin and rennin in acutely ill children: implication for fluid therapy. Acta Paediatr 85:550–553

    Article  CAS  PubMed  Google Scholar 

  9. Neville KA, Verge CF, O'Meara MW, Walker JL (2005) High antidiuretic hormone levels and hyponatraemia in children with gastroenteritis. Pediatrics 116:1401–1407

    Article  PubMed  Google Scholar 

  10. Arieff AI, Ayus JC, Fraser CL (1992) Hyponatraemia and death or permanent brain damage in healthy children. Br Med J 304:1218–1222

    Article  CAS  Google Scholar 

  11. Armour A (1997) Dilutional hyponatraemia: a cause of massive fatal intra-operative cerebral edema in a child undergoing renal transplantation. J Clin Pathol 50:444–446

    Article  CAS  PubMed  Google Scholar 

  12. Bohn D (1999) Children are another group at risk of hyponatraemia peri-operatively. Br Med J 319:1269

    CAS  Google Scholar 

  13. Halberthal M, Halperin ML, Bohn D (2001) Lesson of the week: acute hyponatraemia in children admitted to hospital: retrospective analysis of factors contributing to its development and resolution. Br Med J 322:780–782

    Article  CAS  Google Scholar 

  14. Moritz ML, Ayus JC (2003) Prevention of hospital-acquired hyponatraemia: A case for using isotonic saline. Pediatrics 111:227–230

    Article  PubMed  Google Scholar 

  15. Holliday MA, Segar WE, Friedman A (2003) Reducing errors in fluid therapy management. Pediatrics 111:424–425

    PubMed  Google Scholar 

  16. Duke T, Molyneux EM (2003) Intravenous fluids for seriously ill children: time to reconsider. Lancet 362:1320–1323

    Article  PubMed  Google Scholar 

  17. Moritz ML, Ayus JC (2004) Hospital-acquired Hyponatraemia: why are there still deaths? Pediatrics 113:1395–1396

    Article  PubMed  Google Scholar 

  18. Taylor D, Durward A (2004) Pouring salt on troubled waters. Arch Dis Child 89:411–414

    Article  CAS  PubMed  Google Scholar 

  19. Hatherill M (2004) Rubbing salt in the wound. Arch Dis Child 89:414–418

    Article  CAS  PubMed  Google Scholar 

  20. Holliday MA (2005) Isotonic Saline Expands Extracellular Fluid and Is Inappropriate for Maintenance Therapy. Pediatrics 115:193–194

    PubMed  Google Scholar 

  21. Moritz ML, Ayus JC (2007) Hospital-acquired hyponatraemia–why are hypotonic parenteral fluids still being used? Nat Clin Pract Nephrol 3:374–382

    Article  CAS  PubMed  Google Scholar 

  22. Pollack MM, Patel KM, Ruttimann UE (1996) PRISM III: An updated Pediatric Risk of Mortality score. Crit Care Med 24:743–752

    Article  CAS  PubMed  Google Scholar 

  23. Shann F, Germer S (1985) Hyponatraemia associated with pneumonia or bacterial meningitis. Arch Dis Child 60:963–966

    Article  CAS  PubMed  Google Scholar 

  24. Hanna S, Tibby SM, Duaward A (2003) Incidence of hypontraemia and hyponatraemic seizures in severe respiratory syncytial virus bronchiolitis. Acta Paediatr Scand 92:430–443

    Article  CAS  Google Scholar 

  25. Singhi S, Dhawan A (1992) Frequency and significance of electrolyte abnormalities in pneumonia. Indian Pediatr 29:735–740

    CAS  PubMed  Google Scholar 

  26. Prasad SV, Singhi S, Chugh KS (1994) Hyponatraemia in sick children seeking pediatric emergency care. Indian Pediatr 31:287–294

    CAS  PubMed  Google Scholar 

  27. Singhi S, Prasad SV, Chugh KS (1994) Hyponatraemia in sick children: A marker of serious illness. Indian Pediatr 31:19–25

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rakesh Lodha.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kannan, L., Lodha, R., Vivekanandhan, S. et al. Intravenous fluid regimen and hyponatraemia among children: a randomized controlled trial. Pediatr Nephrol 25, 2303–2309 (2010). https://doi.org/10.1007/s00467-010-1600-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-010-1600-4

Keywords

Navigation