Maintenance fluid therapy in children
- Michael J Somers, MD
Michael J Somers, MD
- Associate Professor of Pediatrics
- Harvard Medical School
Fluid therapy preserves the normal volume and composition of body fluids and, if needed, corrects any existing abnormalities. In children, the most common clinical abnormality requiring fluid therapy is hypovolemia, primarily due to vomiting and diarrhea from gastroenteritis.
Thus, it is clinically useful to divide fluid therapy into two potential components: provision of volume for homeostatic needs (maintenance therapy), and provision of fluid for deficit requirements (repletion therapy).
●Maintenance therapy replaces the ongoing losses of water and electrolytes occurring via normal physiologic processes. These will vary depending on the patient’s underlying clinical status and setting.
●Repletion therapy replaces the water and electrolyte deficits that have accrued via some perturbation in normal processes. Repletion returns the patient to a normal volume and electrolyte status. Thus, in a patient who is hypovolemic, fluid therapy will include both repletion and maintenance therapy.
Maintenance fluid therapy, including alterations in maintenance requirements, will be reviewed here. Assessment of hypovolemia and treatment of dehydration are discussed elsewhere. (See "Clinical assessment and diagnosis of hypovolemia (dehydration) in children" and "Treatment of hypovolemia (dehydration) in children".)
- Hellerstein S. Fluid and electrolytes: clinical aspects. Pediatr Rev 1993; 14:103.
- HOLLIDAY MA, SEGAR WE. The maintenance need for water in parenteral fluid therapy. Pediatrics 1957; 19:823.
- Foster BA, Tom D, Hill V. Hypotonic versus isotonic fluids in hospitalized children: a systematic review and meta-analysis. J Pediatr 2014; 165:163.
- McNab S, Ware RS, Neville KA, et al. Isotonic versus hypotonic solutions for maintenance intravenous fluid administration in children. Cochrane Database Syst Rev 2014; 12:CD009457.
- McNab S, Duke T, South M, et al. 140 mmol/L of sodium versus 77 mmol/L of sodium in maintenance intravenous fluid therapy for children in hospital (PIMS): a randomised controlled double-blind trial. Lancet 2015; 385:1190.
- Holliday MA, Friedman AL, Segar WE, et al. Acute hospital-induced hyponatremia in children: a physiologic approach. J Pediatr 2004; 145:584.
- Choong K, Kho ME, Menon K, Bohn D. Hypotonic versus isotonic saline in hospitalised children: a systematic review. Arch Dis Child 2006; 91:828.
- Choong K, Arora S, Cheng J, et al. Hypotonic versus isotonic maintenance fluids after surgery for children: a randomized controlled trial. Pediatrics 2011; 128:857.
- Friedman AL, Ray PE. Maintenance fluid therapy: what it is and what it is not. Pediatr Nephrol 2008; 23:677.
- Gerigk M, Gnehm HE, Rascher W. Arginine vasopressin and renin in acutely ill children: implication for fluid therapy. Acta Paediatr 1996; 85:550.
- Khan I, Zimmerman B, Brophy P, Kamath S. Masking of syndrome of inappropriate antidiuretic hormone secretion: the isonatremic syndrome. J Pediatr 2014; 165:722.
- Hanna S, Tibby SM, Durward A, Murdoch IA. Incidence of hyponatraemia and hyponatraemic seizures in severe respiratory syncytial virus bronchiolitis. Acta Paediatr 2003; 92:430.
- Neville KA, Sandeman DJ, Rubinstein A, et al. Prevention of hyponatremia during maintenance intravenous fluid administration: a prospective randomized study of fluid type versus fluid rate. J Pediatr 2010; 156:313.
- Coulthard MG, Long DA, Ullman AJ, Ware RS. A randomised controlled trial of Hartmann's solution versus half normal saline in postoperative paediatric spinal instrumentation and craniotomy patients. Arch Dis Child 2012; 97:491.
- Friedman A. Maintenance fluid therapy: what's next. J Pediatr 2014; 165:14.
- MAINTENANCE WATER NEEDS
- - Method 1
- - Method 2
- - Comparison between methods
- Sensible and insensible water loss
- Variability in maintenance water needs
- MAINTENANCE ELECTROLYTE NEEDS
- MAINTENANCE PARENTERAL THERAPY
- Hospitalized children
- - SIADH
- - Our approach
- SUMMARY AND RECOMMENDATIONS