Randomised controlled trial of intravenous maintenance fluids
Version of Record online: 25 NOV 2007
© 2007 The Authors. Journal compilation © 2007 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
Journal of Paediatrics and Child Health
Volume 45, Issue 1-2, pages 9–14, January/February 2009
How to Cite
Yung, M. and Keeley, S. (2009), Randomised controlled trial of intravenous maintenance fluids. Journal of Paediatrics and Child Health, 45: 9–14. doi: 10.1111/j.1440-1754.2007.01254.x
- Issue online: 19 JAN 2009
- Version of Record online: 25 NOV 2007
- Accepted for publication 23 May 2007.
- fluid therapy;
Aim: Traditional paediatric intravenous maintenance fluids are prescribed using hypotonic fluids and the weight-based 4:2:1 formula for administration rate. However, this may cause hyponatraemia in sick and post-operative children. We studied the effect of two types of intravenous maintenance fluid and two administration rates on plasma sodium concentration in intensive care patients.
Methods: A Factorial-design, double-blind, randomised controlled trial was used. We randomised 50 children with normal electrolytes without hypoglycaemia who needed intravenous maintenance fluids for >12 h to 0.9% saline (normal saline) or 4% dextrose and 0.18% saline (dextrose saline), at either the traditional maintenance fluid rate or 2/3 of that rate. The main outcome measure was change in plasma sodium from admission to 12–24 h later.
Results: Fifty patients (37 surgical) were enrolled. Plasma sodium fell in all groups: mean fall 2.3 (standard deviation 4.0) mmol/L. Fluid type (P = 0.0063) but not rate (P = 0.12) was significantly associated with fall in plasma sodium. Dextrose saline produced a greater fall in plasma sodium than normal saline: difference 3.0, 95% confidence interval 0.8–5.1 mmol/L. Full maintenance rate produced a greater fall in plasma sodium than restricted rate, but the difference was small and non-significant: 1.6 (−0.7, 3.9) mmol/L. Fluid type, but not rate, remained significant after adjustment for surgical status. One patient, receiving normal saline at restricted rate, developed asymptomatic hypoglycaemia.
Conclusion: Sick and post-operative children given dextrose saline at traditional maintenance rates are at risk of hyponatraemia.