Fuchs Jennifer, Adams Sarah T, Byerley Julie
Department of Hospitalist Medicine, Children`s Medical Center Dallas, UT Southwestern Medical Center, 1935 Medical District Drive, Mailstop E3.09, Dallas, TX 75235. United States.
Division of General Pediatrics and Adolescent Medicine, University of North Carolina and NC Children`s Hospital, Chapel Hill, NC. United States.
Rev Recent Clin Trials. 2017;12(4):284-289. doi: 10.2174/1574887112666170816145122.
Fluid and electrolyte therapy is an important component in the care of the hospitalized child. Previous pediatric guidelines have followed the Holliday-Segar method of calculating and delivering maintenance IV fluids, using hypotonic fluids in maintenance therapy. However, research demonstrates that hypotonic fluids can lead to iatrogenic hyponatremia and that isotonic fluid is a safer alternative.
To provide the ideal approach to intravenous (IV) fluid use in the hospitalized child and determine the safety and effectiveness of isotonic maintenance fluid therapy.
We searched PubMed, Medline, Cochrane Controlled Clinical Trials Register, and Clinical- Trials.gov for potentially relevant publications from the last five years (2011 to July 2016) with an emphasis on randomized control trials (RCTs) and contemporary evidence-based treatment guidelines.
For maintenance IV fluids, isotonic solutions decreased risk of hyponatremia and did not increase risk of hypernatremia. Some studies demonstrate increased ADH production or hyponatremia on admission for hospitalized patients.
While there is no ideal composition of maintenance IV fluids for all children, isotonic fluids are safer than hypotonic fluids for use as maintenance in hospitalized children due to the decreased risk of iatrogenic hyponatremia. This article also provides recommendations for other types of fluid management in the inpatient pediatric population.
液体和电解质治疗是住院儿童护理的重要组成部分。以往的儿科指南遵循霍利迪-西加尔方法来计算和提供维持性静脉输液，在维持治疗中使用低渗液。然而，研究表明低渗液可导致医源性低钠血症，而等渗液是更安全的选择。
提供住院儿童静脉输液的理想方法，并确定等渗维持液治疗的安全性和有效性。
我们检索了PubMed、Medline、Cochrane对照临床试验注册库和ClinicalTrials.gov，以查找过去五年（2011年至2016年7月）潜在相关的出版物，重点是随机对照试验（RCT）和当代循证治疗指南。
对于维持性静脉输液，等渗溶液降低了低钠血症风险，且未增加高钠血症风险。一些研究表明住院患者入院时抗利尿激素分泌增加或出现低钠血症。
虽然不存在适用于所有儿童的理想维持性静脉输液成分，但由于医源性低钠血症风险降低，等渗液在住院儿童中作为维持液使用比低渗液更安全。本文还为住院儿科患者的其他类型液体管理提供了建议。
