Comparison of Parenteral Maintenance Isotonic and Hypotonic Fluid Therapies administered to Hospitalized Children In Terms of Hyponatremia Risk

Objective: Isotonic fluids are recommended for parenteral maintenance fluid therapy because they reduce morbidity and mortality due to iatrogenic hyponatremia in children.However, there is still an ongoing debate regarding the ideal fluid therapy to be used in children.This study aims to provide insight into the development of hyponatremia in patients using hypotonic and isotonic fluids for maintenance and the comparative effects of these fluid regimens. Method:The study included hospitalized patients aged 1 to 83 months between January 2021 and June 2022, with normal serum sodium levels and given maintenance fluid therapy.Patients were categorized into three maintenance fluid groups: 0.3% saline (0.3% saline in 3.3% dextrose), 0.45% saline (0.45% saline in 5% dextrose), and normal saline (0.9% saline in 5% dextrose).The groups were further stratified based on control sodium level measurement times (8-16 hours, 17-32 hours, and 33-48 hours), and data were compared with baseline sodium levels. Results:The study involved 215 patients aged 1-83 months.There was no significant difference between the groups in terms of initial serum sodium levels.However, comparing control sodium levels revealed significant distinctions between each group (respectively, 0.3% saline and 0.45% saline groups (p=0.009),0.45% saline and normal saline (p=0.003),0.3% saline and normal saline groups (p<0,001).Significantly, the difference between baseline and control sodium values varied across fluid groups (p<0.001).Treatment duration did not impact the sodium level change. Conclusion:Using hypotonic fluids in pediatric maintenance fluid therapy elevates the risk of hospital-acquired hyponatremia.Opting for isotonic fluids in parenteral maintenance therapy is safer.