Choong Karen, Bohn Desmond
Division of Pediatric Critical Care, Department of Paediatrics, McMaster University, Hamilton, ON, Canada.
J Pediatr (Rio J). 2007 May;83(2 Suppl):S3-S10. doi: 10.2223/JPED.1614. Epub 2007 Apr 26.
To examine electrolyte-free water requirements that should be considered when administering maintenance fluids in a critically ill child. We examine some of the difficulties in estimating these requirements, and discuss the controversies with respect to the traditional recommendations.
MEDLINE (1966-2007), Embase (1980-2007), and the Cochrane Library, using the terms fluid therapy, hypotonic, isotonic solution, and synonyms or related terms.
The ideal maintenance solution and fluid regimen remains a topic of heated debate in pediatrics. The traditional recommendations for maintenance fluids are increasingly criticized as they do not consistently apply in acute illness, where energy expenditure and electrolyte requirements deviate significantly from the original estimates. A physiologically based framework for prescribing maintenance fluids is presented, with the objective of maintaining tonicity balance, and infusing the minimum volume of maintenance fluid required to maintain hemodynamics. Indications for isotonic and hypotonic solutions are discussed.
Maintenance fluid prescriptions should be individualized. No single intravenous solution is ideal for every child during all phases of illness, but there is evidence to suggest that the safest empirical choice is an isotonic solution. Hypotonic solutions should only be considered if the goal is to achieve a positive free-water balance. Critically ill children may require a reduction by as much as 40-50% of the currently recommended maintenance volumes. All patients receiving intravenous fluids should be monitored closely with daily weights, fluid balances, biochemical and clinical parameters in order to best guide this therapy.
探讨在危重症患儿进行维持性补液时应考虑的无电解质水需求量。我们研究了估算这些需求量时存在的一些困难，并讨论了与传统建议相关的争议。
检索MEDLINE（1966 - 2007年）、Embase（1980 - 2007年）和Cochrane图书馆，使用的检索词为液体疗法、低渗、等渗溶液以及同义词或相关术语。
理想的维持性补液溶液和补液方案仍是儿科学领域激烈争论的话题。传统的维持性补液建议受到越来越多的批评，因为它们在急性疾病中并不总是适用，此时能量消耗和电解质需求量与最初的估计有显著偏差。提出了一个基于生理学的维持性补液处方框架，目标是维持张力平衡，并输注维持血流动力学所需的最小维持液量。讨论了等渗和低渗溶液的适应证。
维持性补液处方应个体化。在疾病的所有阶段，没有一种单一的静脉溶液对每个儿童都是理想的，但有证据表明，最安全的经验性选择是等渗溶液。只有当目标是实现正的自由水平衡时，才应考虑低渗溶液。危重症患儿可能需要将目前推荐的维持液量减少多达40% - 50%。所有接受静脉输液的患者都应通过每日体重、液体平衡、生化和临床参数进行密切监测，以便最好地指导这种治疗。
