Isotonic versus Hypotonic Intravenous Maintenance Fluids in Children: A Randomized Controlled Trial.

Abstract

To compare the incidence of hyponatremia during the first 48h in hospitalized children receiving normal saline vs. N/2 saline as maintenance intravenous fluid. This open label, randomized controlled trial to compare the incidence of hyponatremia in hospitalized children receiving normal saline (0.9% sodium chloride in 5% dextrose) vs. N/2 saline (0.45% sodium chloride in 5% dextrose) as maintenance fluid was conducted from December 2014 through November 2015 in a tertiary care teaching hospital. Children between 1 mo and 18 y requiring maintenance intravenous fluids were randomized to receive normal saline with 5% dextrose (n = 75) or N/2 saline with 5% dextrose (n = 75). Both groups were comparable for demographic variables and illness severity at baseline. Incidence of hyponatremia at 24h of hospitalization was comparable between normal saline and N/2 saline group, 3(4%) vs. 6(8%) cases, respectively; p value 0.494. Mean serum sodium levels were marginally higher in normal saline group (138.3 ± 6.0mEq/L) as compared with N/2 saline group (135.1 ± 4.4mEq/L) (p value <0.01) at 24h of hospitalization. Incidence of hyponatremia at 48h and hypernatremia at 24 and 48h was comparable in two groups. The use of either N/2 saline or normal saline in sick children at standard maintenance fluid rates is associated with low but comparable incidence of hypo or hypernatremia in first 24h of hospitalization. Both types of fluids appear acceptable in hospitalized sick children.