Hypotonic versus Isotonic Fluids in Hospitalized Children: A Systematic Review and Meta-Analysis

Objective To determine whether the use of hypotonic vs isotonic maintenance fluids confers an increased risk of hyponatremia in hospitalized children. Study design A search of MEDLINE (1946 to January 2013), the Cochrane Central Registry (1991 to December 2012), Cumulative Index for Nursing and Alli...

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Bibliographic Details
Published in:The Journal of pediatrics 2014-07, Vol.165 (1), p.163-169.e2
Main Authors: Foster, Byron Alexander, MD, MPH, Tom, Dina, MD, Hill, Vanessa, MD
Format: Article
Language:English
Subjects:
Child
Child, Hospitalized
Child, Preschool
Fluid Therapy - methods
Humans
Hyponatremia - etiology
Hypotonic Solutions - administration & dosage
Hypotonic Solutions - adverse effects
Infant
Infusions, Intravenous
Isotonic Solutions - administration & dosage
Isotonic Solutions - adverse effects
Pediatrics
Risk
Risk Assessment
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Summary:Objective To determine whether the use of hypotonic vs isotonic maintenance fluids confers an increased risk of hyponatremia in hospitalized children. Study design A search of MEDLINE (1946 to January 2013), the Cochrane Central Registry (1991 to December 2012), Cumulative Index for Nursing and Allied Health Literature (1990 to December 2012), and Pediatric Academic Societies (2000-2012) abstracts was conducted using the terms “hypotonic fluids/saline/solutions” and “isotonic fluids/saline/solutions,” and citations were reviewed using a predefined protocol. Data on the primary and secondary outcomes were extracted from original articles by 2 authors independently. Meta-analyses of the primary and secondary outcomes were performed when possible. Results A total of 1634 citations were screened. Ten studies (n = 893) identified as independent randomized controlled trials were included. Five studies examined subjects in the intensive care unit setting, including 4 on regular wards and 1 in a mixed setting. In hospitalized children receiving maintenance intravenous fluids, hyponatremia was seen more often in those receiving hypotonic fluids than in those receiving isotonic fluids, with an overall relative risk of 2.37 (95% CI, 1.72-3.26). Receipt of hypotonic fluids was associated with a relative risk of moderate hyponatremia (
ISSN:0022-3476
1097-6833
DOI:10.1016/j.jpeds.2014.01.040