Approach to intravenous infusion therapy for children with dehydration

Abstract

For appropriate intravenous infusion therapy, it is important to recognize that volume depletion and dehydration are distinct clinical conditions, and to understand the physiology of total body water distribution in the body fluid compartment. Traditionally, early rapid infusion with an isotonic crystalloid fluid has been used for severely dehydrated children and those in shock; however, in recent years, restrictive intravenous fluid therapy has become the preferred practice because of concerns regarding the safety of early rapid infusion. Historically, hypotonic solutions, based on the Holliday-Segar (HS) formula, have been used for maintenance intravenous fluid therapy. However, isotonic solutions with a more restricted infusion volume than that calculated using the HS formula have become the treatment of choice in view of iatrogenic hyponatremia associated with the syndrome of inappropriate antidiuretic hormone secretion in pediatric patients. Overall, it is important to recognize that infusion therapy can cause serious complications in children. As there is no firm consensus on the best approach for intravenous fluid resuscitation and maintenance therapy, it is necessary to repeatedly assess changes in the child’s clinical presentation related to infusion therapy, and modify the infusion approach for a more appropriate therapy.