title: Hypotonic versus isotonic saline in hospitalised children: a systematic review.
abstract: BACKGROUND
  The traditional recommendations which suggest that hypotonic intravenous (i.v.) maintenance fluids are the solutions of choice in paediatric patients have not been rigorously tested in clinical trials, and may not be appropriate for all children.
  
  
  OBJECTIVE
  To systematically review the evidence from studies evaluating the safety of administering hypotonic versus isotonic i.v. maintenance fluids in hospitalised children.
  
  
  METHODS
  
  
  
  METHODS
  Medline (1966-2006), Embase (1980-2006), the Cochrane Library, abstract proceedings, personal files, and reference lists. Studies that compared hypotonic to isotonic maintenance solutions in children were selected. Case reports and studies in neonates or patients with a pre-existing history of hyponatraemia were excluded.
  
  
  RESULTS
  Six studies met the selection criteria. A meta-analysis combining these studies showed that hypotonic solutions significantly increased the risk of developing acute hyponatraemia (OR 17.22; 95% CI 8.67 to 34.2), and resulted in greater patient morbidity.
  
  
  CONCLUSIONS
  The current practice of prescribing i.v. maintenance fluids in children is based on limited clinical experimental evidence from poorly and differently designed studies, where bias could possibly raise doubt about the results. They do not provide evidence for optimal fluid and electrolyte homoeostasis in hospitalised children. This systematic review indicates potential harm with hypotonic solutions in children, which can be anticipated and avoided with isotonic solutions. No single fluid rate or composition is ideal for all children. However, isotonic or near-isotonic solutions may be more physiological, and therefore a safer choice in the acute phase of illness and perioperative period.
authors.affiliation: Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada. choongk@mcmaster.ca
authors.forename: K
authors.initials: K
authors.lastname: Choong
authors.forename: M E
authors.initials: ME
authors.lastname: Kho
authors.forename: K
authors.initials: K
authors.lastname: Menon
authors.forename: D
authors.initials: D
authors.lastname: Bohn
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D000075202:Contraindications; D019317:Evidence-Based Medicine; D005440:Fluid Therapy / Q000009:adverse effects* / Q000379:methods; D006760:Hospitalization; D006801:Humans; D007010:Hyponatremia / Q000209:etiology; D007223:Infant; D007552:Isotonic Solutions; D012462:Saline Solution, Hypertonic / Q000009:adverse effects*; D012965:Sodium Chloride / Q000009:adverse effects*
chemical_list: D007552:Isotonic Solutions; D012462:Saline Solution, Hypertonic; D012965:Sodium Chloride