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Published in: Indian Journal of Pediatrics 11/2019

01-11-2019 | Hypernatremia | Editorial Commentary

Maintenance Intravenous Fluids in Children – The Verdict was Already Out?

Authors: Javed Ismail, Jhuma Sankar

Published in: Indian Journal of Pediatrics | Issue 11/2019

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Excerpt

Maintenance intravenous fluid (IVF) is a common and essential part of treatment in hospitalized children to maintain hydration in those in whom enteral fluid intake is not possible. An ideal IVF should match the daily fluid volume requirements and should contain electrolytes in appropriate concentrations to replenish ongoing loss and daily needs. There has been an ongoing debate on the tonicity of IVF for maintenance requirements over the past few decades. Tonicity or osmotic pressure exerted by the IVF on the semipermeable cell wall membrane is determined by the electrolyte concentration; the major contributor being sodium. Hypotonic maintenance IVF has been traditionally used in children based on theoretical calculations by Holliday and Segar in 1950s which yielded a fluid composition of 3 mEq/dL of sodium and 2 mEq/dL of potassium [1]. In acutely ill states, excess secretion of arginine vasopressin retains free water and can exacerbate hyponatremia associated with administration of hypotonic fluids. This results in a range of mild to severe hyponatremia, in extreme cases manifesting as hyponatremic encephalopathy. Isotonic fluids have been recommended since 2003 as a maintenance IVF in hospitalized children to prevent these complications [2]. In recent years, there has been a fear of inducing complications like hypernatremia, volume overload, edema and hypertension with use of isotonic saline. …
Literature
1.
go back to reference Holliday MA, Segar WE. The maintenance need for water in parenteral fluid therapy. Pediatrics. 1957;19:823–32.PubMed Holliday MA, Segar WE. The maintenance need for water in parenteral fluid therapy. Pediatrics. 1957;19:823–32.PubMed
2.
go back to reference Moritz ML, Ayus JC. Prevention of hospital-acquired hyponatremia: a case for using isotonic saline. Pediatrics. 2003;111:227–30.CrossRef Moritz ML, Ayus JC. Prevention of hospital-acquired hyponatremia: a case for using isotonic saline. Pediatrics. 2003;111:227–30.CrossRef
4.
go back to reference Feld LG, Neuspiel DR, Foster BA, et al. Clinical practice guideline: maintenance intravenous fluids in children. Pediatrics. 2018;142:e20183083.CrossRef Feld LG, Neuspiel DR, Foster BA, et al. Clinical practice guideline: maintenance intravenous fluids in children. Pediatrics. 2018;142:e20183083.CrossRef
Metadata
Title
Maintenance Intravenous Fluids in Children – The Verdict was Already Out?
Authors
Javed Ismail
Jhuma Sankar
Publication date
01-11-2019
Publisher
Springer India
Published in
Indian Journal of Pediatrics / Issue 11/2019
Print ISSN: 0019-5456
Electronic ISSN: 0973-7693
DOI
https://doi.org/10.1007/s12098-019-03049-5

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