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

  • Narendra K Bagri
  • Vidya K Saurabh
  • Sriparna Basu
  • Ashok KumarEmail author
Original Article



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.


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).


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.


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.


Children Hypotonic fluids Maintenance fluids Normal saline N/2 saline 


Authors’ Contribution

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.

Compliance with Ethical Standards

Conflict of Interest



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Copyright information

© Dr. K C Chaudhuri Foundation 2019

Authors and Affiliations

  1. 1.Department of Pediatrics, Institute of Medical SciencesBanaras Hindu UniversityVaranasiIndia

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