title: Hypotonic versus isotonic maintenance fluids in critically ill pediatric patients: a randomized controlled trial.
abstract: Hypotonic fluids have been associated with the development of iatrogenic hyponatremia.
  
  
  
  To assess variations in serum sodium (sNa) following the intravenous administration of isotonic maintenance fluids (0.9% NaCl/5% dextrose) compared to hypotonic maintenance fluids (0.45% NaCl/5% dextrose).
  
  
  
  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 fluids >80% of total maintenance fluids. Serum Na level was measured before administering maintenance fluids and when reducing the administration to <80% of total fluids.
  
  
  
  The study included 63 patients who were randomly assigned to receive hypotonic (n= 32) or isotonic (n= 31) maintenance fluids. Baseline characteristics were similar in both groups. There were no differences in terms of volume of fluid 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 fluids (hypotonic group: 137.8 ± 4.3 mmol/L; isotonic group: 140.0 ± 4.1 mmol/L, p= 0.04). None of these two maintenance fluids increased the risk of hyponatremia (Na 145 mmol/L).
  
  
  
  Neither hypotonic nor isotonic maintenance fluids increased the risk of developing iatrogenic hyponatremia with the 24 hour infusion.
authors.affiliation: Pediatric Intensive Care Unit, Hospital de Niños Pedro de Elizalde, Buenos Aires City, Argentina. jorrobox@yahoo.com.ar
authors.forename: Facundo A
authors.initials: FA
authors.lastname: Jorro Barón
authors.forename: Claudia N
authors.initials: CN
authors.lastname: Meregalli
authors.forename: Valeria A
authors.initials: VA
authors.lastname: Rombolá
authors.forename: Cecilia
authors.initials: C
authors.lastname: Bolasell
authors.forename: Vilma E
authors.initials: VE
authors.lastname: Pigliapoco
authors.forename: Silvia E
authors.initials: SE
authors.lastname: Bartoletti
authors.forename: Gustavo E
authors.initials: GE
authors.lastname: Debaisi
mesh_terms: D016638:Critical Illness / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007038:Hypotonic Solutions / Q000627:therapeutic use; D007223:Infant; D007262:Infusions, Intravenous; D008297:Male; D011446:Prospective Studies; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use; D012964:Sodium / Q000097:blood; D012965:Sodium Chloride / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D007038:Hypotonic Solutions; D012462:Saline Solution, Hypertonic; D012965:Sodium Chloride; D012964:Sodium