EFFECT OF NORMAL SALINE VS RINGER LACTATE AS MAINTENANCE FLUID ON SERUM ELECTROLYTES IN CRITICALLY ILL PATIENTS IN PICU

Background: Intravenous fluid therapy plays a critical role in preserving extracellular volume and maintaining electrolyte balance in acutely ill children. The American Academy of Pediatrics (2018) and NICE (2020) recommend isotonic crystalloids such as Normal Saline (NS) and Ringer Lactate (RL) as maintenance fluids. However, their differing electrolyte compositions raise concern-NS with higher chloride may cause hyperchloremic metabolic acidosis, whereas RL, with added potassium and lower chloride, may influence electrolyte balance. Objective: To compare serum electrolytes in critically ill children receiving NS vs RL as maintenance fluid in PICU. This prospective observational Methods: study was conducted in the Pediatric ICU of M.S. Ramaiah Hospital (June 2023 – February 2025). Two hundred children aged 2 months–18 years received either NS or RL based on clinical need. Serum sodium, potassium, and chloride were measured at baseline and after 24 hours. NS Results: group showed higher mean serum sodium (139.45 mEq/L vs 138.3 mEq/L; p = 0.0016) and chloride (107.35 mEq/L vs 102.68 mEq/L; p < 0.0001). Hyperchloremia occurred in 15.5 % (NS) vs 0.5 % (RL). RL maintained potassium more stably; mild hypokalemia occurred in 3 % (NS) vs 0.5 % (RL). Conclusion: RL showed better electrolyte profile compared to NS with reduced risk of sodium and chloride elevation and better potassium conservation.