Maintenance fluid therapy in children
- Michael J Somers, MD
Michael J Somers, MD
- Associate Professor of Pediatrics
- Harvard Medical School
The goal of fluid therapy is to preserve the normal volume and electrolyte composition of body fluids. Fluid therapy is usually divided into two components:
●Maintenance therapy replaces the ongoing daily losses of water and electrolytes occurring via physiologic processes (urine, sweat, respiration, and stool), which normally preserve homeostasis. Maintenance requirements vary depending on the patient's underlying clinical status and setting especially in postoperative or hospitalized children due to changes in their physiologic responses (eg, excess antidiuretic hormone [ADH] secretion).
●Repletion therapy corrects water and acute electrolyte deficits that have accrued via illness or physiologic abnormality. Repletion returns the patient to a normal volume and electrolyte status.
Maintenance fluid therapy, including alterations in maintenance requirements, will be reviewed here. Assessment of hypovolemia and repletion therapy are discussed elsewhere. (See "Clinical assessment and diagnosis of hypovolemia (dehydration) in children" and "Treatment of hypovolemia (dehydration) in children".)
COMPONENTS OF FLUID THERAPY
Normal physiologic needs — Homeostatic control for water is dependent on antidiuretic hormone (ADH) release, the kidney's ability to regulate urinary water losses, and water intake based on thirst (see "General principles of disorders of water balance (hyponatremia and hypernatremia) and sodium balance (hypovolemia and edema)", section on 'Regulation of water and sodium balance'). These regulatory mechanisms allow for variability in the daily water intake in healthy children without adverse effect.
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- COMPONENTS OF FLUID THERAPY
- - Normal physiologic needs
- - Methods for calculation
- Changes in maintenance needs
- - Changes in water loss
- - Impaired ADH action
- PRESCRIBING MAINTENANCE PARENTERAL FLUID THERAPY
- General principles
- Hospitalized children
- - Isotonic versus hypotonic solution
- - Isotonic therapy: maintenance volume versus volume restriction
- - Our approach
- SUMMARY AND RECOMMENDATIONS