Intravenous Fluid Management in the Pediatric Hospital Setting: Is Isotonic Fluid the Right Approach for all Patients?

Abstract

The purpose of the study is to review the recent controversy in the optimal tonicity of maintenance intravenous fluids for pediatric patients and to suggest strategies for the selection of maintenance fluid rate and composition for the pediatric hospitalist. The goals of maintenance intravenous fluid management are to preserve adequate effective circulating volume, maintain normal electrolytes, and avoid fluid overload. Wide practice variation exists in the provision of maintenance fluids for pediatric patients admitted to the general ward. Two recent meta-analyses have favored isotonic over hypotonic main-tenance fluids to avoid iatrogenic hyponatremia. However, the generalizability of these findings are limited as randomized studies have focused on postoperative patients and ICU settings, comparisons in terms of fluid composition have been widely variable, few studies have examined the rate of fluid administration, and there has been insufficient examina-tion of potential adverse effects of increased solute load. In the midst of such controversy, the pediatric hospitalist must critically evaluate current evidence when choosing