From the Guidelines
The most common maintenance fluid should be an isotonic solution, such as 0.9% Normal Saline (NS), to reduce the risk of hyponatremia in pediatric patients. According to the American Academy of Pediatrics (AAP) clinical practice guideline 1, isotonic fluids should be administered to children who are acutely ill and require maintenance IVFs to prevent the development of hyponatremia. This recommendation is supported by a systematic review and meta-analysis published in the Journal of Pediatrics 1, which found that isotonic fluids significantly decrease the risk of developing hyponatremia in pediatric patients.
The European Society of Pediatric and Neonatal Intensive Care (ESPNIC) also recommends the use of isotonic fluids for maintenance IVFT in acute and critically ill children, as stated in their clinical practice guidelines 1. These guidelines emphasize the importance of using isotonic fluids to reduce the risk of hyponatremia and promote optimal fluid management in pediatric patients.
In terms of specific fluid composition, the AAP recommends that patients 28 days to 18 years of age requiring maintenance IVFs should receive isotonic solutions with appropriate KCl and dextrose 1. The addition of dextrose provides approximately 170 calories per liter, preventing ketosis during periods of fasting.
It is essential to note that fluid requirements should be adjusted based on the patient's clinical condition, accounting for factors such as fever, increased insensible losses, or underlying medical conditions. The use of balanced crystalloid solutions like Lactated Ringer's may be preferred for longer-term maintenance, as they can help prevent hyperchloremic metabolic acidosis associated with prolonged use of normal saline.
Overall, the use of isotonic solutions, such as 0.9% Normal Saline (NS), is recommended as the most common maintenance fluid for pediatric patients to reduce the risk of hyponatremia and promote optimal fluid management.
From the Research
Maintenance Fluids
- The most common maintenance fluids used in various studies include normal saline, dextrose-supplemented saline, lactated Ringer solution, Plasma-Lyte, and 5% Dextrose in Ringer's Lactate 2, 3, 4.
- Normal saline is often used as a maintenance fluid, but its effects on metabolic balance can differ from other solutions such as dextrose-supplemented saline and lactated Ringer solution 2.
- Lactated Ringer solution is another commonly used maintenance fluid, and its effects on plasma bicarbonate and blood glucose have been studied in comparison to normal saline and dextrose-supplemented saline 2, 4.
Comparison of Maintenance Fluids
- A study comparing Plasma-Lyte and Lactated Ringer's in surgical intensive care unit trauma patients found that Plasma-Lyte was associated with prolonged hospital and SICU length of stay, but no difference in mortality 3.
- A randomized controlled trial comparing 5% Dextrose in Ringer's Lactate and 5% Dextrose Normal Saline as maintenance intravenous fluid therapy in children found a statistically significant difference in serum chloride levels between the two groups 4.
- The incidence of hyperchloremic metabolic acidosis and acute kidney injury was also compared between the two groups, with varying results 4.
Effects on Metabolic Balance
- The effects of different maintenance fluids on metabolic balance, including sodium, potassium, bicarbonate, and glucose levels, have been studied in various populations, including children and critically ill patients 2, 3, 4.
- The choice of maintenance fluid can have significant effects on metabolic balance, and a personalized approach to fluid therapy may be necessary to minimize adverse effects 2.