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Maintenance fluid therapy in children

Author
Michael J Somers, MD
Section Editor
Tej K Mattoo, MD, DCH, FRCP
Deputy Editor
Melanie S Kim, MD

INTRODUCTION

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

Water

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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Literature review current through: Jan 2016. | This topic last updated: Jan 26, 2016.
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References
Top
  1. HOLLIDAY MA, SEGAR WE. The maintenance need for water in parenteral fluid therapy. Pediatrics 1957; 19:823.
  2. Hellerstein S. Fluid and electrolytes: clinical aspects. Pediatr Rev 1993; 14:103.
  3. Neilson J, O'Neill F, Dawoud D, et al. Intravenous fluids in children and young people: summary of NICE guidance. BMJ 2015; 351:h6388.
  4. Foster BA, Tom D, Hill V. Hypotonic versus isotonic fluids in hospitalized children: a systematic review and meta-analysis. J Pediatr 2014; 165:163.
  5. 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.
  6. Padua AP, Macaraya JR, Dans LF, Anacleto FE Jr. Isotonic versus hypotonic saline solution for maintenance intravenous fluid therapy in children: a systematic review. Pediatr Nephrol 2015; 30:1163.
  7. 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.
  8. Choong K, Kho ME, Menon K, Bohn D. Hypotonic versus isotonic saline in hospitalised children: a systematic review. Arch Dis Child 2006; 91:828.
  9. 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.
  10. 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.
  11. Wang J, Xu E, Xiao Y. Isotonic versus hypotonic maintenance IV fluids in hospitalized children: a meta-analysis. Pediatrics 2014; 133:105.
  12. Moritz ML, Ayus JC. Maintenance Intravenous Fluids in Acutely Ill Patients. N Engl J Med 2015; 373:1350.
  13. Friedman A. Maintenance fluid therapy: what's next. J Pediatr 2014; 165:14.
  14. Friedman AL, Ray PE. Maintenance fluid therapy: what it is and what it is not. Pediatr Nephrol 2008; 23:677.
  15. Gerigk M, Gnehm HE, Rascher W. Arginine vasopressin and renin in acutely ill children: implication for fluid therapy. Acta Paediatr 1996; 85:550.