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.  in routine clinical practice? The
external validity of the study is quite limited as there were so
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
, and meningitis . 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
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
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.
5. Maconochie IK, Bhaumik S. Fluid therapy for acute
bacterial meningitis. Cochrane Database Syst Rev 2014;5:CD004786.