Can I use Plasma-Lyte (PLR) for maintenance fluids in an 8-year-old child?

Use of Plasma-Lyte (PLR) for Maintenance Fluids in an 8-Year-Old Child

Yes, Plasma-Lyte (PLR) is recommended as a maintenance fluid for an 8-year-old child as it is a balanced isotonic solution that can reduce length of stay and avoid electrolyte abnormalities. 1

Rationale for Using Plasma-Lyte

• Balanced solutions (like Plasma-Lyte) should be used when prescribing intravenous maintenance fluid therapy in acutely ill children to slightly reduce length of stay 1
• Isotonic maintenance fluids are strongly recommended in acutely and critically ill children to reduce the risk of hyponatremia 1
• Plasma-Lyte is a balanced crystalloid solution that avoids the hyperchloremic metabolic acidosis associated with normal saline 2

Fluid Volume Considerations

• For an 8-year-old child, maintenance fluid requirements should be calculated using the Holliday and Segar formula 1:

  • First 10 kg: 100 mL/kg/day (1000 mL)
  • Next 10 kg: 50 mL/kg/day (approximately 400 mL for an average 8-year-old)
  • Total: approximately 1400 mL/day or 60 mL/hour 1

• Consider fluid restriction if the child has conditions associated with increased ADH secretion:

  • Restrict to 65-80% of calculated maintenance volume to avoid fluid overload 1
  • For children with heart failure, renal failure, or hepatic failure, restrict to 50-60% of calculated maintenance 1, 3

Monitoring Recommendations

• Monitor electrolytes, especially sodium levels, regularly during maintenance fluid therapy 1
• Assess fluid balance and clinical status at least daily 1
• Monitor blood glucose at least daily, especially when using fluids containing dextrose 1
• Watch for signs of fluid overload or electrolyte disturbances 1

Important Considerations and Precautions

• Avoid lactate buffer solutions if the child has severe liver dysfunction to prevent lactic acidosis 1, 3
• Consider the total daily fluid intake including IV medications, infusions, and enteral intake to prevent fluid overload 1
• If the child can tolerate oral or enteral fluids, consider transitioning from IV to enteral route to reduce complications 1
• Potassium supplementation should be guided by regular monitoring of potassium levels 1

Advantages of Plasma-Lyte Over Other Solutions

• Plasma-Lyte is associated with fewer biochemical abnormalities compared to 0.9% saline 2
• Balanced solutions like Plasma-Lyte help avoid hyperchloremic metabolic acidosis seen with normal saline 4
• Studies show that isotonic fluids significantly reduce the risk of hyponatremia compared to hypotonic fluids (5.1% vs 20.6%) 5
• Balanced solutions may result in a slight reduction in hospital length of stay compared to 0.9% saline 2

Common Pitfalls to Avoid

• Avoid hypotonic fluids which significantly increase the risk of hyponatremia in children 5, 6
• Be cautious about fluid overload which can lead to prolonged mechanical ventilation and increased length of stay 1
• Don't forget to account for all sources of fluid input when calculating total daily fluid requirements 1
• Remember that maintenance fluids differ from replacement fluids for abnormal losses 1