Conditions: Hyponatremia
Keywords: hyponatremia maintenance solutions pediatrics
Allocation: RANDOMIZED | Intervention model: PARALLEL
Enrollment: 66
Healthy volunteers: no

Brief summary:
The primary objective of this study is to compare the mean serum sodium after 48 hours of therapy with either 0.45% NaCl/dextrose 5% or 0.9% NaCl/dextrose 5%, in critically ill children requiring IV maintenance fluid administration.

Detailed description:
In patients without possibilities of oral intake, maintenance fluids provide electrolytes and water. Since the original descriptions by Holliday and Segar, the recommended standard maintenance solutions are based on "physiological needs", containing 30-50 mEq/L of sodium.

However hyponatremia has become increasingly recognized in hospitalized children suggesting that Holliday and Segar's recommendations are frequently inappropriately applied.

It has been described augmented intersticial lung water in patients receiving hypotonic maintenance solutions. Also, hyponatremia has been demonstrated in post-surgery critically ill children receiving hypotonic maintenance solutions.

More over, non-physiologic antidiuretic hormone (ADH) secretion has been described in the great majority of hospitalized children due to nausea, stress, pain, and/or surgical interventions.

It has been suggested that isotonic 0.9% NaCl/dextrose 5% should be the standard maintenance intravenous (IV) solution, to avoid the development of hyponatremia.

There are not studies in critically ill children evaluating the effect of isotonic solutions on sodium levels.

Arms:
arm 1: Subjects in this arm will receive 0.45% NaCl/5% dextrose intravenous maintenance fluids. arm 2: Subjects in this arm will receive 0.9% NaCl/5% dextrose intravenous maintenance fluids.

Interventions: intervention 1: hypotonic intervention 2: isotonic
Intervention descriptions: intervention 1: 0.45% NaCl/5% dextrose IV maintenance fluids intervention 2: 0.9% NaCl/5% dextrose IV maintenance fluids

Protocol document: