Review Article

J Pediatr (Rio J). 2011;87(6):478-86: Isotonic solutions, hypotonic solutions, fluid therapy, hyponatremia, child, hospitalization.

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Objectives: This review aims to evaluate if the use of hypotonic saline solutions as maintenance intravenous fluid therapy in hospitalized children increases the risk of hyponatremia, if the administration of isotonic fluids is able to protect against acquired hyponatremia and if the isotonic solutions increase the risks of deleterious effects such as hypernatremia or fluid overload.
Sources: We researched the relevant literature on the PubMed (Jan 01 1969 to Jul 13 2011), EMBASE (1989 to 2011) and Cochrane Library (1989 to 2011) databases. Furthermore, references of selected studies were included.
Summary of the findings: Hospitalized children are potentially at risk of developing hyponatremia and the use of hypotonic saline solutions is the main risk factor for this disease. Isotonic saline solutions have shown a protective effect against hyponatremia, and, so far, there have been no significant deleterious effects such as fluid overload, hypernatremia or phlebitis.
Conclusions: The evidence found indicates that the traditional recommendation of Holliday and Segar to use maintenance fluid therapy for sick and hospitalized children deserves to be reconsidered due to the adverse effects found to arise from it, apart from the better results obtained by using isotonic solutions.