2019 Volume 32 Issue 2 Pages 77-85
It remains challenging to adequately assess abnormalities in water and electrolyte balance and to determine what type of intravenous fluids is favorable for sick children. The use of hypotonic fluids has been reported to be a cause of hospital-acquired hyponatremia and isotonic fluids are recommended as maintenance intravenous fluids by clinical guidelines. However, it is not shown that hypotonic fluids significantly increase symptomatic hyponatremia or mortality compared with isotonic fluids. Therefore, it remains unclear whether isotonic fluids should be used in all children who need maintenance intravenous fluids. It is highly advised to monitor plasma electrolytes after initiation of intravenous fluids based on the assessment of the risk of nonosmotic secretion of anti-diuretic hormone. Concurrently, the assessment of total exchangeable cations and total body water is quite helpful in the management of sick children with abnormalities in water and electrolyte balance.
