title: Hypotonic versus isotonic maintenance fluids in critically ill children: a multicenter prospective randomized study.
abstract: OBJECTIVE
  Study the influence of hypotonic (HT) and isotonic (IT) maintenance fluids in the incidence of dysnatraemias in critically ill children.
  
  
  METHODS
  Prospective, randomized study conducted in three paediatric intensive care units (PICU). One hundred and twenty-five children requiring maintenance fluid therapy were included: 62 received HT fluids (50-70 mmol/L tonicity) and 63 IT fluids (156 mmol/L tonicity). Age, weight, cause of admission, sodium and fluid intake, and diuresis were collected. Blood electrolytes were measured on admission, 12 and 24 h later.
  
  
  RESULTS
  Blood sodium levels at 12 h were 133.7±2.7 mmol/L in HT group vs. 136.8±3.5 mmol/L in IT group (p=0.001). Adjusted for age, weight and sodium level at PICU admission, the blood sodium values of patients receiving HT fluids decrease by 3.22 mmol/L (CI: 4.29/2.15)(p=0.000). Adjusted for age, weight and hyponatraemia incidence at admission, patients receiving HT fluids increased the risk of hyponatraemia by 5.8-fold (CI: 2.4-14.0) during the study period (p=0.000).
  
  
  CONCLUSIONS
  Hypotonic maintenance fluids increase the incidence of hyponatraemia because they decrease blood sodium levels in normonatraemic patients. IT maintenance fluids do not increase the incidence of dysnatraemias and should be considered as the standard maintenance fluids.
authors.affiliation: Paediatric Intensive Care Unit, Department of Paediatrics, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Asturias, Spain. corsino.rey@sespa.princast.es
authors.forename: Corsino
authors.initials: C
authors.lastname: Rey
authors.forename: Marta
authors.initials: M
authors.lastname: Los-Arcos
authors.forename: Arturo
authors.initials: A
authors.lastname: Hernández
authors.forename: Amelia
authors.initials: A
authors.lastname: Sánchez
authors.forename: Juan-José
authors.initials: JJ
authors.lastname: Díaz
authors.forename: Jesús
authors.initials: J
authors.lastname: López-Herce
mesh_terms: D002648:Child; D016638:Critical Illness; D005440:Fluid Therapy; D006801:Humans; D007010:Hyponatremia / Q000209:etiology; D007038:Hypotonic Solutions / Q000008:administration & dosage* / Q000009:adverse effects; D007262:Infusions, Intravenous; D015278:Intensive Care Units, Pediatric; D007552:Isotonic Solutions / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D007038:Hypotonic Solutions; D007552:Isotonic Solutions