Comparison of the effect of isotonic and hypotonic saline solutions for children with mild dehydration at Lampang Hospital

Abstract

Administering the appropriate type and rate of fluids is crucial for pediatric patients. Young patients should be given isotonic solutions, as they are safer than hypotonic solutions for fluid maintenance. However, limited studies exist on the efficacy and complications of isotonic solutions for treating acutely ill pediatric patients with mild dehydration. This study aimed to compare isotonic and hypotonic solutions in such cases. A stratified randomized controlled trial was conducted on patients aged 6 months to 15 years with acute illness and mild dehydration in two disease groups: acute gastroenteritis and other diseases. The trial involved administering intravenous fluids, either isotonic or hypotonic solution, for at least 24 hours. Pre and post-treatment serum sodium levels and treatment complications were assessed and compared between patients who received isotonic and hypotonic solutions. A total of 144 patients were randomly assigned to receive either isotonic solution or hypotonic solution. Of the 144 patients, 72 received isotonic and 72 received hypotonic solutions. The isotonic group comprised 51.4% males with a median age of 27.5 months. On the other hand, the hypotonic group comprised 56.9% males with a median age of 38 months. At baseline, both groups' sodium levels were similar at 136.2±2.5 and 136.8±2.5 mmol/L, respectively. After 24 hours, the isotonic group had a statistically significant increase in sodium levels (138.8±2.2 mmol/L; increased median 2.3) compared to the hypotonic group (138.1±2.0 mmol/L; increased median 1.5). In conclusion, no cases of hypernatremia, drowsiness, or seizures were observed, suggesting isotonic solutions can be safely used in these selected groups of acutely ill pediatric patients with mild dehydration.