A Randomized Study of Isotonic Versus Hypotonic Maintenance Intravenous Fluids in Hospitalized Children in a Tertiary Institution in Nigeria, Sub-Saharan Africa
Odion-Obomhense Helen K1; OcheiOboratare2&Otene Cletus3
1Paediatric Surgical Unit, Department of Surgery, Delta State University Teaching Hospital, Oghara,
2Department of Community Health, Community Medicine, Delta State University Teaching Hospital
3Plastic Surgical Unit, Department of Surgery, Delta State University Teaching Hospital, Oghara,
Email:***drkesoghene@gmail.com;droboratare@gmail.com;oteneclet@yahoo.com
ABSTRACT:
Maintenance intravenous fluids are administered to hospitalized children who cannot maintain adequate hydration through the enteral intake. Isotonic crystalloids have been said to be a safer alternative to hypotonic solutions as intravenous maintenance fluids to prevent hyponatremia; however, in many pediatric units in Nigeria, hypotonic fluids are still routinely administered.This study was done to assess the complications and the change in serum sodium that arose in patients that had either hypotonic or isotonic intravenous fluids pre-operatively and post-operatively for maintenance. The study was a randomized clinical study conducted among children aged 6 months to 17 years, who required intravenous fluids for at least 8 hours. The children used for the study were randomized into three arms; either they received 5.0% dextrose in normal saline or 5% dextrose in ringers’ lactate or, 4.3% dextrose in one-fifth saline. The primary outcome variable was to determine acute hyponatremic state; while the secondary outcome variables measured were severe hyponatremia, hypernatremia, or, any adverse events attributable to acute plasma sodium level changes. The study showed a significantly higher risk of acute hyponatremia and severe hyponatremia in patients who received hypotonic intravenous fluids than in patients who received isotonic fluids. However, there was no significant difference found in the risk of hypernatremia in patients who received either hypotonic intravenous fluids or isotonic fluids.Isotonic fluids are safer than hypotonic fluids in hospitalized children requiring maintenance intravenous fluids therapy to prevent
hyponatremia.
