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

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. …