Things We Do For No Reason: The Default Use of Hypotonic Maintenance Intravenous Fluids in Pediatrics

• When needed, maintenance IV fluids should always be tailored to each individual patient.
• For most acutely ill hospitalized children, isotonic IV fluids should be the maintenance IV fluid of choice.
• Consider monitoring electrolytes to determine the effects of maintenance IV fluids.

Enteral maintenance fluids should be used first-line if possible. Although hypotonic IV fluids have historically been the maintenance IV fluid of choice, this class of IV fluids should be avoided for most hospitalized children to decrease the significant risk of iatrogenic hyponatremia, which can be severe and have catastrophic complications. When necessary, isotonic IV fluids should be used for the majority of hospitalized children given that these fluids present a significantly decreased risk for causing hyponatremia. Returning to our case presentation, to decrease the risk of hyponatremia, the senior resident should recommend starting isotonic IV fluids in the 12-month-old and theoretical 2-week-old until oral intake can be maintained.

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Disclosure

The authors have no relevant conflicts of interest to report. No payment or services from a 3rd party were received for any aspect of this submitted work. The authors have no financial relationships with entities in the biomedical arena that could be perceived to influence, or that give the appearance of potentially influencing, what was written in this submitted work.