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Correspondence

Indian Pediatr 2015;52: 442

What is Ideal Maintenance Intravenous Fluid in Children?


*NK Bagri and A Kumar

Department of Pediatrics, Institute of Medical Sciences, BHU, Varanasi, UP, India.
Email: drnarendrabagri@yahoo.co.in 

 
 
 


We read with interest the recently published randomized controlled trial and accompanying editorials on the choice of maintenance fluids in hospitalized sick children [1-3]. We have following comments:

1. How do we use the results of the study by Shamim, et al. [1] in routine clinical practice? The external validity of the study is quite limited as there were so many exclusions.

2. The reason for 60% restriction of isotonic fluid is contrary to current recommendations of giving normal volume of maintenance fluids in common conditions such as bronchiolitis [4], and meningitis [5]. Authors have themselves acknowledged the risk of dehydration and hypernatremia with continued administration of restricted volume isotonic fluids beyond 24 hours. This leaves us in dilemma about with a difficult choice of the type of maintenance fluids to be used beyond 24 hours of hospitalization.

3. In view of the high incidence of hyponatremia associated with the use of 0.18% NaCl in 5% Dextrose as maintenance fluid, its use is no longer justified in current pediatric practice.

Keeping these points in mind, there is need of large pragmatic trials to provide answers to questions not addressed by the present trial.

References

1. Shamim A, Afzal K, Ali M. 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.

2. Jayyashree M, Baalaji AR. Choice of maintenance fluids - does it hold water? Indian Pediatr. 2014;51:963-4.

3. Narsaria P, Lodha R. Isnít it time to stop using 0.18% saline in dextrose solutions for intravenous maintenance fluid therapy in children? Indian Pediatr. 2014;5:964-5.

4. Ralston Shawn L, Liebertha SA, Meissner HC, Alverson BK, Baley JE, Gadomski AM, et al. Clinical Practice Guideline: The diagnosis, management and prevention of bronchiolitis. Pediatrics. 2014;134:e1474-1502.

5. Maconochie IK, Bhaumik S. Fluid therapy for acute bacterial meningitis. Cochrane Database Syst Rev 2014;5:CD004786.

 

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