“Maintenance” of a traditional stance

Abstract

The past few years have been witness to a very disturbing series of articles, which have promoted a dangerous approach to pediatric fluid therapy based upon a fundamental misunderstanding of physiology. In brief, the articles in question advocated the use of isotonic solutions as the “maintenance” fluid in children. The rationale for this departure from decades of teaching has been a misinterpretation of some cases of severe hyponatremia developing in children receiving more dilute fluid. Specifically, most of these cases were in children with some degree of volume contraction, for whom “routine maintenance” fluids would not have been appropriate anyway. In this issue of The Journal, several distinguished experts in pediatric fluid therapy, including some who were involved in the very early development of our current concepts, review this controversy. This is a timely discussion of the topic. It should serve as a nice review of the basic physiology involved for the beginning student of pediatric fluid therapy. For the seasoned practitioner, it outlines in a compelling fashion why such a major change in our approach to maintenance fluid therapy is unwise and unwarranted. Acute hospital-induced hyponatremia in children: A physiologic approachThe Journal of PediatricsVol. 145Issue 5PreviewPhysicians giving children fluid therapy today seldom encounter overt dehydration or signs of shock that call for rapid and aggressive extracellular fluid (ECF) expansion. Physicians in the era when severe diarrheal dehydration was common first restored ECF with isotonic saline,a then planned maintenance and replacement therapies, using hypotonic saline. Today, physicians plan fluid therapy mostly for children with pneumonia, meningitis, other acute disorders, or for children scheduled for surgery. Full-Text PDF