Isotonic solutions best for children needing IV Fluids-AAP latest Guideline

American Academy of Pediatrics has released its latest guideline on Maintenance Intravenous Fluids in children. According to new AAP clinical practice guideline, children who require maintenance intravenous fluids (IVFs) should receive isotonic solutions with appropriate potassium chloride and dextrose to decrease the risk of developing hyponatremia.

Maintenance intravenous fluids, IV Fluids are used to provide critical supportive care for children who are acutely ill. Despite the common use of maintenance IV Fluids, there is high variability in fluid prescribing practices and a lack of guidelines for fluid composition and electrolyte monitoring.

The aim of this guideline is to provide an evidence-based approach for choosing the tonicity of maintenance IV Fluids in most patients from 28 days to 18 years of age who require maintenance IV Fluids. These recommendations do not apply to patients with neurosurgical disorders, congenital or acquired cardiac disease, hepatic disease, cancer, renal dysfunction, diabetes insipidus, voluminous watery diarrhoea severe burns; neonates who are younger than 28 days old or in the NICU; or adolescents older than 18 years old.

IV Fluids are required if sufficient fluids cannot be provided by using enteral administration for reasons such as gastrointestinal illness, respiratory compromise, neurologic impairment, a perioperative state, or being moribund from an acute or chronic illness.

The administration of hypotonic IV Fluids has been the standard in paediatrics. But concerns have been raised that this approach results in a high incidence of hyponatremia and that isotonic IV Fluids could prevent the development of hyponatremia. The new guideline specifically addresses the tonicity of maintenance IV Fluids in children.

The Key Action Statement of the subcommittee is as follows:

1A: The American Academy of Pediatrics recommends that patients 28 days to 18 years of age requiring maintenance IV Fluids should receive isotonic solutions with appropriate potassium chloride and dextrose because they significantly decrease the risk of developing hyponatremia (evidence quality: A; recommendation strength: strong)

For the past 60 years, the prescription for maintenance IVFs for infants and children has been a hypotonic fluid. These recommendations were made on theoretical grounds and were not based on clinical trials. This guideline will certainly change this age-old practice.

For full Guideline log on to :

http://pediatrics.aappublications.org/content/pediatrics/early/2018/11/21/peds.2018-3083.full.pdf