title: Isotonic versus Hypotonic Parenteral Maintenance Fluids in Very Severe Pneumonia.
abstract: OBJECTIVE
  To compare the risk of hyponatremia between hypotonic and isotonic parenteral maintenance solutions (PMS) administered to children with very severe pneumonia, admitted in the general pediatric ward.
  
  
  METHODS
  A randomized controlled open label trial was conducted in the pediatrics department of a tertiary care medical college hospital including euvolemic children 2 mo to 5 y of age, fulfilling the WHO clinical definition of very severe pneumonia and requiring PMS. They were randomized to receive either isotonic PMS (0.9% saline in 5% dextrose and potassium chloride 20 meq/L) or hypotonic PMS (0.18% saline in 5% dextrose and potassium chloride 20 meq/L) at standard rates for next 24 h.
  
  
  RESULTS
  A total of 119 children were randomized (59: Isotonic; 60: Hypototonic PMS). Nine (15%) children in the isotonic PMS group and 29 (48%) in the hypotonic PMS group developed hyponatremia during the study period, (p <0.001) with a relative risk being 3.16 (95% CI 1.64 to 6.09). Mean serum sodium was significantly lower in the hypotonic group compared to the isotonic group (p < 0.001 each at 6, 12 and 24 h). The difference in mean change in serum sodium from baseline was also significant at 12 and 24 h (5.4 and 5.8 meq/L respectively; p < 0.001 each).
  
  
  CONCLUSIONS
  This study demonstrates the rationality of the use of isotonic PMS in children with respiratory infections, a condition regularly encountered by most pediatricians.
authors.affiliation: Department of Pediatrics, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, 110001, India.
authors.forename: Subramaniam
authors.initials: S
authors.lastname: Ramanathan
authors.affiliation: Department of Pediatrics, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, 110001, India.
authors.forename: Praveen
authors.initials: P
authors.lastname: Kumar
authors.affiliation: Department of Pediatrics, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, 110001, India. kirtisen@gmail.com.
authors.forename: Kirtisudha
authors.initials: K
authors.lastname: Mishra
authors.affiliation: Department of Pediatrics, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, 110001, India.
authors.forename: Ashok Kumar
authors.initials: AK
authors.lastname: Dutta
mesh_terms: D002675:Child, Preschool; D016903:Drug Monitoring; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007010:Hyponatremia / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D007038:Hypotonic Solutions / Q000008:administration & dosage / Q000009:adverse effects / Q000737:chemistry; D007223:Infant; D007262:Infusions, Intravenous / Q000379:methods; D007552:Isotonic Solutions / Q000008:administration & dosage / Q000009:adverse effects / Q000737:chemistry; D008297:Male; D011014:Pneumonia; D012720:Severity of Illness Index; D012965:Sodium Chloride / Q000008:administration & dosage / Q000097:blood; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007038:Hypotonic Solutions; D007552:Isotonic Solutions; D012965:Sodium Chloride
keywords: Hyponatremia; Maintenance fluid; Pediatrics; Pneumonia