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Intravenous fluid therapy

Pediatric Research volume 94, pages 1261–1262 (2023)Cite this article

The article published by Roberts et al.1 raises some issues of clinical interest, particularly at present, as maintenance fluid therapy protocols based on the recommendations of Holliday and Segar2 have been replaced by standard administration of isotonic intravenous fluids to avoid the risk of hyponatremia.3,4,5

In their study, Roberts et al.1 show that judicious use of hypotonic solutions as maintenance therapy in euvolemic pediatric patients with normal renal function is not associated with hyponatremia. This is consistent with our clinical experience, which indicates that, after rapid restoration of extracellular fluid volume (ECF) with isotonic fluid, which should be the first priority of fluid therapy for patients with ECF dehydration, followed, if possible, by oral rehydration therapy, the use of hypotonic fluids calculated according to the recommendations of Holliday and Segar2 does not imply an increased risk of clinically significant hyponatremia when the infusion rate is adequately controlled on the basis of pathophysiological criteria and the patient’s response.

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References

  1. Roberts, D. N. et al. Perioperative water and electrolyte balance and water homeostasis regulation in children with acute surgery. Pediatr. Res. https://doi.org/10.1038/s41390-023-02509-1 (2023).

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  2. Holliday, M. A. & Segar, W. E. The maintenance need for water in parenteral fluid therapy. Pediatrics 19, 823–832 (1957).

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  3. NICE. NICE guideline. Intravenous fluid therapy in children and young people in hospital. www.nice.org.uk/guidance/ng29 (2015).

  4. Friedman, J. N. et al. Comparison of isotonic and hypotonic intravenous maintenance fluids: a randomized clinical trial. JAMA Pediatr. 169, 445–451 (2015).

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  5. Feld, L. G. et al. Clinical practice guideline: maintenance intravenous fluids in children. Pediatrics 142, e20183083 (2018).

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  6. Garcia, N. H., Stoos, B. A., Carretero, O. A. & Garvin, J. L. Mechanism of the nitric oxide-induced blockade of collecting duct water permeability. Hypertension 27, 679–683 (1996).

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Funding

Funding

This work was partly supported by the Fundación Nutrición y Crecimiento, Asturias, Spain.

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Authors and Affiliations

  1. Division of Pediatric Nephrology, Department of Pediatrics, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain

    Fernando Santos

  2. Department of Medicine, University of Oviedo, Oviedo, Asturias, Spain

    Fernando Santos

  3. Division of Pediatric Nephrology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Jorge R. Ferraris

  4. Universidad de Buenos Aires, Buenos Aires, Argentina

    Jorge R. Ferraris

Authors
  1. Fernando Santos
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  2. Jorge R. Ferraris
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Contributions

J.R.F. came up with the idea for the article and proposed its writing. F.S. wrote the initial draft. Both authors reviewed and approved the final version.

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Correspondence to Fernando Santos.

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The authors declare no competing interests.

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Santos, F., Ferraris, J.R. Intravenous fluid therapy. Pediatr Res 94, 1261–1262 (2023). https://doi.org/10.1038/s41390-023-02635-w

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