Abstract

JORRO BARON, Facundo A. et al. Hypotonic versus isotonic maintenance fuids in critically ill pediatric patients. Arch. argent. pediatr. [online]. 2013, vol.111, n.4, pp.281-287. ISSN 0325-0075.  http://dx.doi.org/10.5546/aap.2013.281.

Introduction. Hypotonic fluids have been associated with the development of iatrogenic hyponatremia. Objectives. To assess variations in serum sodium (sNa) following the intravenous administration of isotonic maintenance fuids (0.9% NaCl/5% dextrose) compared to hypotonic maintenance fuids (0.45% NaCl/5% dextrose). Material and Methods. Randomized, controlled, double-blind clinical trial. Pediatric patients with an expected length of stay in the intensive care unit of more than 24 hours were enrolled, with normal serum Na, and IV fuids >80% of total maintenance fuids. Serum Na level was measured before administering maintenance fuids and when reducing the administration to <80% of total fuids. Results. The study included 63 patients who were randomly assigned to receive hypotonic (n= 32) or isotonic (n= 31) maintenance fuids. Baseline characteristics were similar in both groups. There were no differences in terms of volume of fuid administered (hypotonic group: 865 ± 853 mL; isotonic group: 778 ± 649 mL; p= 0.654) or infusion duration (hypotonic group: 24 ± 10.8 hours; isotonic group: 27.6 ± 12.8 hours; p= 0.231). A difference was found in the serum Na following the administration of maintenance fuids (hypotonic group: 137.8 ± 4.3 mmol/L; isotonic group: 140.0 ± 4.1 mmol/L, p= 0.04). None of these two maintenance fuids increased the risk of hyponatremia (Na 145 mmol/L). Conclusions. Neither hypotonic nor isotonic maintenance fluids increased the risk of developing iatrogenic hyponatremia with the 24 hour infusion.

Keywords : IV fuids; Hypotonic; Isotonic; Clinical trial.

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