Current Issues in Intravenous Fluid Use in Hospitalized Children.

BACKGROUND: Fluid and electrolyte therapy is an important component in the care of the hospitalized child. Previous pediatric guidelines have followed the Holliday-Segar method of calculating and delivering maintenance IV fluids, using hypotonic fluids in maintenance therapy. However, research demonstrates that hypotonic fluids can lead to iatrogenic hyponatremia and that isotonic fluid is a safer alternative.

OBJECTIVE: To provide the ideal approach to intravenous (IV) fluid use in the hospitalized child and determine the safety and effectiveness of isotonic maintenance fluid therapy.

METHOD: We searched PubMed, Medline, Cochrane Controlled Clinical Trials Register, and Clinical- Trials.gov for potentially relevant publications from the last five years (2011 to July 2016) with an emphasis on randomized control trials (RCTs) and contemporary evidence-based treatment guidelines.

RESULTS: For maintenance IV fluids, isotonic solutions decreased risk of hyponatremia and did not increase risk of hypernatremia. Some studies demonstrate increased ADH production or hyponatremia on admission for hospitalized patients.

CONCLUSION: While there is no ideal composition of maintenance IV fluids for all children, isotonic fluids are safer than hypotonic fluids for use as maintenance in hospitalized children due to the decreased risk of iatrogenic hyponatremia. This article also provides recommendations for other types of fluid management in the inpatient pediatric population.