Abstract
BackgroundThe principles for maintenance intravenous fluid prescription in children were developed in the 1950s. These guidelines based on the use of hypotonic solutions have been challenged regularly for they seem to be associated with an increased risk of hospital-acquired hyponatremia.Case presentationWe report the case of a 4-week-old Caucasian child admitted for acute bronchiolitis who received hypotonic maintenance fluids and developed severe hyponatremia (94 mmol/L) with hyponatremic encephalopathy.ConclusionThis clinical situation can serve as a reminder of the latest recommendations from the American Academy of Pediatrics regarding the use of intravenous fluids that promote the use of isotonic fluids in children.
Highlights
The principles for maintenance intravenous fluid prescription in children were developed in the 1950s
Severe hyponatremia is defined as a plasma sodium level < 125 mmol/L and is associated with hyponatremic encephalopathy [8, 9], a spectrum of symptoms related to cerebral edema
We present the case of a 4-week-old child admitted for acute bronchiolitis who received hypotonic Maintenance intravenous fluids (MIVF) and developed hyponatremic encephalopathy
Summary
Maintenance intravenous fluids (MIVF) prescription practices are highly variable among pediatricians [1]. Blood tests at admission reported hyponatremia and hyperkalemia (Na+ 126 mmol/L, K+ 5.6 mmol/L, bicarbonate 22.3 mmol/L, creatinine 20 μmol/L, urea 5.4 mmol/L, white blood cells (WBC) 9.2 × 109/L, hemoglobin (Hb) 10.9 g/dL, platelets (Plt) 553 × 109/L, C-reactive protein (CRP) < 5 mg/L) (Fig. 2) She received continuous intravenous infusion of hypotonic fluid (sodium chloride 34 mmol/L, potassium 20 mmol/L, calcium 2.26 mmol/L, and glucose 5%) at a rate of 122 mL/kg/day, plus enteral feeding via nasogastric tube (130 mL/kg/day), supplemental oxygen 0.5 L/ minute, respiratory physiotherapy, and oral betamethasone (0.375 mg once daily for 2 days). HR was at 175 bpm, BP 120/68 mmHg, RR 40/minute, and saturation 100% under high-flow oxygen therapy with FiO2 30% She had inspiratory dyspnea with severe respiratory distress, and other clinical signs were normal. She suffers from moderate asthma and is fed by a gastrostomy because of an orality disorder
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