Skip to main content

Advertisement

SpringerLink
Log in

Isotonic versus Hypotonic Intravenous Maintenance Fluids in Children: A Randomized Controlled Trial

  • Original Article
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Objective

To compare the incidence of hyponatremia during the first 48 h in hospitalized children receiving normal saline vs. N/2 saline as maintenance intravenous fluid.

Methods

This open label, randomized controlled trial to compare the incidence of hyponatremia in hospitalized children receiving normal saline (0.9% sodium chloride in 5% dextrose) vs. N/2 saline (0.45% sodium chloride in 5% dextrose) as maintenance fluid was conducted from December 2014 through November 2015 in a tertiary care teaching hospital. Children between 1 mo and 18 y requiring maintenance intravenous fluids were randomized to receive normal saline with 5% dextrose (n = 75) or N/2 saline with 5% dextrose (n = 75).

Results

Both groups were comparable for demographic variables and illness severity at baseline. Incidence of hyponatremia at 24 h of hospitalization was comparable between normal saline and N/2 saline group, 3(4%) vs. 6(8%) cases, respectively; p value 0.494. Mean serum sodium levels were marginally higher in normal saline group (138.3 ± 6.0 mEq/L) as compared with N/2 saline group (135.1 ± 4.4 mEq/L) (p value <0.01) at 24 h of hospitalization. Incidence of hyponatremia at 48 h and hypernatremia at 24 and 48 h was comparable in two groups.

Conclusions

The use of either N/2 saline or normal saline in sick children at standard maintenance fluid rates is associated with low but comparable incidence of hypo or hypernatremia in first 24 h of hospitalization. Both types of fluids appear acceptable in hospitalized sick children.

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

Access this article

Log in via an institution

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. Holliday MA, Segar WE, Friedman A, Chesney R, Finberg L. Intravenous fluids for seriously ill children. Lancet. 2004;363:241.

    Article  Google Scholar 

  2. Foster BA, Tom D, Hill V. Hypotonic versus isotonic fluids in hospitalized children: a systematic review and meta-analysis. J Pediatr. 2014;165:163–9.

    Article  Google Scholar 

  3. Wang J, Xu E, Xiao Y. Isotonic versus hypotonic maintenance IV fluids in hospitalized children: a meta-analysis. Pediatrics. 2014;133:105–13.

    Article  Google Scholar 

  4. Arieff AI, Ayus JC, Fraser CL. Hyponatraemia and death or permanent brain damage in healthy children. BMJ. 1992;304:1218–22.

    Article  CAS  Google Scholar 

  5. Bohn D. Children are another group at risk of hyponatraemia peri-operatively. BMJ. 1999;319:1269.

    Article  CAS  Google Scholar 

  6. Armour A. Dilutional hyponatraemia: a cause of massive fatal intra-operative cerebral edema in a child undergoing renal transplantation. J Clin Pathol. 1997;50:444–6.

    Article  CAS  Google Scholar 

  7. Halberthal M, Halperin ML, Bohn D. Lesson of the week: acute hyponatraemia in children admitted to hospital: retrospective analysis of factors contributing to its development and resolution. BMJ. 2001;322:780–2.

    Article  CAS  Google Scholar 

  8. Moritz ML, Ayus JC. Hospital-acquired hyponatraemia–why are hypotonic parenteral fluids still being used? Nat Clin Pract Nephrol. 2007;3:374–82.

    Article  CAS  Google Scholar 

  9. Rey C, Los-Arcos M, Hernandez A, Sanchez A, Diazz JJ, Lopez-Herce J. Hypotonic versus isotonic maintenance fluids in critically ill children: a multicenter prospective randomized study. Acta Paediatr. 2011;100:1138–43.

    Article  Google Scholar 

  10. Shann F, Pearson G, Slater A, Wilkinson K. Paediatric index of mortality (PIM): a mortality prediction model for children in intensive care. Intensive Care Med. 1997;23:201–7.

    Article  CAS  Google Scholar 

  11. Chow E, Fox N, Gama R. Effect of low serum total protein on sodium and potassium measurement by ion-selective electrodes in critically ill patients. Br J Biomed Sci. 2008;65:128–31.

    Article  CAS  Google Scholar 

  12. Kim H, Kim JK, Cho SC. Comparison of sodium ion levels between an arterial blood gas analyzer and an autoanalyzer in preterm infants admitted to the neonatal intensive care unit: a retrospective study. BMC Pediatr. 2016;16:101.

    Article  Google Scholar 

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

    Article  CAS  Google Scholar 

  14. Hoorn EJ, Geary D, Robb M, Halperin ML, Bohn D. Acute hyponatraemia related to intravenous fluid administration in hospitalized children: an observational study. Pediatrics. 2004;113:1279–84.

    Article  Google Scholar 

  15. Brazel PW, McPhee IB. Inappropriate secretion of antidiuretic hormone in postoperative scoliosis patients: the role of fluid management. Spine. 1996;21:724–7.

    Article  CAS  Google Scholar 

  16. Choong K, Kho M, Menon K, Bohn D. Hypotonic versus isotonic saline in hospitalised children: a systematic review. Arch Dis Child. 2006;91:828–35.

    Article  CAS  Google Scholar 

  17. Neville KA, Verge CF, Rosenberg AR, O'Meara MW, Walker JL. Isotonic is better than hypotonic saline for intravenous rehydration of children with gastroenteritis: a prospective randomised study. Arch Dis Child. 2006;91:226–32.

    Article  CAS  Google Scholar 

  18. Armon K, Riordan A, Playfor S, Millman G, Khader A, Society PR. Hyponatraemia and hypokalaemia during intravenous fluid administration. Arch Dis Child. 2008;93:285–7.

    Article  CAS  Google Scholar 

  19. Duke T, Mokela D, Frank D, et al. Management of meningitis in children with oral fluid restriction or intravenous fluid at maintenance volumes: a randomized trial. Ann Trop Pediatr. 2002;22:145–57.

    Article  Google Scholar 

  20. Hoorn EJ, Geary D, Robb M, Halperin ML, Bohn D. Acute hyponatraemia related to intravenous fluid administration in hospitalized children: an observational study. Pediatrics. 2004;113:1279–84.

    Article  Google Scholar 

  21. Kannan L, Lodha R, Vivekanandhan S, Bagga A, Kabra SK, Kabra M. Intravenous fluid regimen and hyponatraemia among children: a randomized controlled trial. Pediatr Nephrol. 2010;25:2303–9.

    Article  Google Scholar 

  22. Shamim K, Afzal K, Ali SM. Safety and efficacy of isotonic (0.9%) vs. hypotonic (0.18%) saline as maintenance intravenous fluids in children: a randomized controlled trial. Indian Pediatr. 2014;51:969–74.

    Article  Google Scholar 

  23. McNab S, Ware RS, Neville KA, et al. Isotonic versus hypotonic solutions for maintenance intravenous fluid administration in children. Cochrane Database Syst Rev. 2014;Issue12:Art. No. CD009457.

  24. Feld LG, Neuspiel DR, Foster BA, et al; Subcommittee on fluid and electrolyte therapy. Clinical practice guideline: maintenance intravenous fluids in children. Pediatrics. 2018;142:e20183083.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India

    Narendra K Bagri, Vidya K Saurabh, Sriparna Basu & Ashok Kumar

Authors
  1. Narendra K Bagri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vidya K Saurabh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sriparna Basu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ashok Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

NKB: Designing the study, monitoring the data collection, interpretation of data and drafting the manuscript; VKS: Data collection and analysis and drafting the manuscript; SB: Analysis of data and drafting the manuscript; AK: Conception and design of the work, drafting and revising the work for important intellectual content. All authors approved the final version of draft. AK is the guarantor for this paper.

Corresponding author

Correspondence to Ashok Kumar.

Ethics declarations

Conflict of Interest

None.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bagri, N.K., Saurabh, V.K., Basu, S. et al. Isotonic versus Hypotonic Intravenous Maintenance Fluids in Children: A Randomized Controlled Trial. Indian J Pediatr 86, 1011–1016 (2019). https://doi.org/10.1007/s12098-019-03011-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12098-019-03011-5

Keywords

Search

Navigation