Parenteral Fluid Therapy in Children

Abstract

Parenteral fluids are commonly administered in the hospital setting. For decades, clinicians have used a standardized approach for the prescription of maintenance IV fluids. Such an approach, however, has led to concerns regarding the development of hyponatremia using hypotonic fluids, especially in settings of heightened ADH release such as hypovolemia. Compared to balanced solutions for IV fluid administration, normal saline use has led to separate concerns regarding the development of hyperchloremic metabolic acidosis and acute kidney injury. A number of randomized controlled trials have shown lower rates of hyponatremia using isotonic fluids when compared to hypotonic fluids. Clinical practice guidelines from the United Kingdom and United States have both recommended isotonic IV fluids for the otherwise healthy child in need of maintenance fluid administration, while those with alterations in water or solute balance require more individualized approaches. Large studies in adults have shown lower rates of acute kidney injury with balanced solutions compared to normal saline although similar data in children is lacking. Retrospective pediatric data has not shown a consistent difference between these interventions. Isotonic fluids should be first line therapy for otherwise healthy children in need of maintenance IV fluids. Evidence for the standard use of balanced solutions in children remains more limited, until large randomized trials can be performed.