Rethinking Intravenous Hydration in Hospitalized Children

F. Bruder Stapleton, MD

Hyponatremia developed more often in children who received hypotonic versus isotonic fluids.

The long-honored recommendation to administer hypotonic intravenous (IV) fluids for maintenance fluid replacement in hospitalized children has recently been challenged because of a possible association with hyponatremia. Investigators examined risk for hyponatremia in a retrospective electronic medical record review of 1048 hospitalized children (2009–2011) with normal serum sodium values at admission; 64% of children received hypotonic maintenance IV fluids (1/4–1/2 normal saline), and 36% received isotonic maintenance IV fluids (normal saline) at admission.

Overall, 35% of children developed hyponatremia (serum sodium <135 mEq/L). In analysis adjusted for baseline differences between the two groups, significantly more children who received hypotonic fluids developed hyponatremia (39% vs. 28%; adjusted odds ratio, 1.37). Hyponatremia also developed more rapidly in the hypotonic-fluid group, and differences between the two cohorts were evident within 2 days. Hyponatremia was more common in children with surgical admissions as well as cardiac, gastrointestinal, hematology-oncology, and nephrology admitting diagnoses.

Citation(s):

Carandang F et al. Association between maintenance fluid tonicity and hospital-acquired hyponatremia. J Pediatr 2013 Sep 3; [e-pub ahead of print].