Médica pediatra. Especialização, Terapia Intensiva Pediátrica, Departamento de Pediatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP.
J Pediatr (Rio J). 2011 Nov-Dec;87(6):478-86. doi: 10.2223/JPED.2133.
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.
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.
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.
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.
本综述旨在评估在住院儿童中使用低张生理盐水作为维持性静脉输液治疗是否会增加低钠血症的风险，等渗液的使用是否能够预防获得性低钠血症，以及等渗溶液是否会增加高钠血症或液体超负荷等有害作用的风险。
我们在 PubMed（1969 年 1 月 1 日至 2011 年 7 月 13 日）、EMBASE（1989 年至 2011 年）和 Cochrane 图书馆（1989 年至 2011 年）数据库中搜索了相关文献。此外，还纳入了选定研究的参考文献。
住院儿童有发生低钠血症的风险，使用低张生理盐水是导致这种疾病的主要危险因素。等渗生理盐水溶液对低钠血症有保护作用，到目前为止，还没有出现液体超负荷、高钠血症或静脉炎等明显的有害作用。
所发现的证据表明，由于使用它会产生不良影响，除了使用等渗溶液可以获得更好的结果外，传统上建议使用维持液疗法治疗生病和住院的儿童，需要重新考虑。
