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Hypotonic and isotonic intravenous maintenance fluids in hospitalised paediatric patients: a randomised controlled trial
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  • Published on:
    Are you administering just "maintenance" fluid?
    • Graham Smith, Consultant Paediatric Nephrologist University Hospital of Wales

    Graham, Smith

    Email Address * smithgc@cardiff.ac.uk

    Occupation * Consultant Paediatric Nephrologist

    Affiliation * University Hospital of Wales

    This is another article on the potential risks of using hypotonic intravenous solutions and the perceived risk of promoting hyponatraemia. I am concerned that this, as with other publications on the topic, uses the term "maintenance fluids" when the fluid being prescribed is also serving the role of "resuscitation" and/or "replacement". While this study may not have seen any cases of hypernatraemia in patients receiving 0.9% saline, we have. The idea that the prescription of just one type of fluid i.e. an isotonic one, is suitable in all paediatric patients covered by this studies' selection criteria reflects laziness on the part of the doctor.

    For accurate prescribing of intravenous fluid, the doctor should think of three different requirements:
    1. Resuscitation fluid
    2. Replacement fluid
    3. Maintenance fluid

    Resuscitation fluid is administered to correct a deficit in the ECF volume. I wonder if this study tries to eliminate this by excluding children with "urinary osmolarity greater than 100 mOsm/kg and a weight change >2% in the first 24 hours". Unfortunately it is not clear by how much the 48 hour study period of fluid administration overlapped with the first 24 hours of admissi...

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    Conflict of Interest:
    None declared.