title: Intravenous fluid management for the acutely ill child.
abstract: OBJECTIVE
  To review the principles of prescribing intravenous fluids (IVFs) to the acutely ill child and of adjusting sodium composition and fluid rate to prevent disorders in serum sodium or volume status from occurring.
  
  
  RESULTS
  Recent data have revealed that the historic approach of administering hypotonic IVFs results in a high incidence of hospital-acquired hyponatremia in children. The majority of hospitalized children requiring IVFs are at risk for developing hyponatremia from numerous stimuli for arginine vasopressin (AVP) production, such as volume depletion, pain, stress, nausea, vomiting, respiratory or central nervous system (CNS) disorders, or the postoperative state. Multiple recent prospective studies in over 600 children have demonstrated that hypotonic fluids cause acute hyponatremia, whereas 0.9% sodium chloride (NaCl) effectively prevents it. 0.9% NaCl is the most appropriate IVF for the majority of hospitalized children. Fluid and sodium restriction will be needed for children with edematous or oliguric states and hypotonic fluids needed for children with urinary or extra-renal free water losses or hypernatremia.
  
  
  CONCLUSIONS
  Hypotonic fluids should not be administered routinely in children due to the risk of hospital-acquired hyponatremia. 0.9% NaCl is the preferred IVF for the vast majority of hospitalized children.
authors.affiliation: Division of Nephrology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, The University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15224, USA. moritzml@upmc.edu
authors.forename: Michael L
authors.initials: ML
authors.lastname: Moritz
authors.forename: Juan C
authors.initials: JC
authors.lastname: Ayus
mesh_terms: D002648:Child; D003422:Critical Care / Q000379:methods*; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D006955:Hypernatremia / Q000517:prevention & control*; D007010:Hyponatremia / Q000150:complications / Q000517:prevention & control*; D007038:Hypotonic Solutions / Q000008:administration & dosage; D020896:Hypovolemia / Q000628:therapy; D007262:Infusions, Intravenous; D012307:Risk Factors; D012965:Sodium Chloride / Q000008:administration & dosage*
chemical_list: D007038:Hypotonic Solutions; D012965:Sodium Chloride