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PHM Focus

Schedule at a Glance

Assessing the Safety of Isotonic Maintenance Fluids

Primary Leader:
Kevin Powell

Co-Leaders:

Objective 1:
Identify the risks and benefits of using isotonic maintenance fluids.

Objective 2:
Identify the factors needed to claim improvements in safety.

Objective 3:


Summary:
The most common medications used by pediatric hospitalists are IV water, salt, and glucose. These have saved countless lives. But, as with all medications, there are risks, including severe hyponatremia, cerebral edema and death. Using higher concentrations of sodium in maintenance fluids for hospitalized children reduces or slows, but does not prevent, the onset of moderate hyponatremia. But would an engineer call them safer? Phrased as a PICO question: In the population of hospitalized children (or an identifiable sub group,) does the injection of an additional 8 mEq of NaCl with every 100 ml of maintenance fluid reduce the all-cause morbidity and mortality? To answer this, the articles included in the most recent meta-analysis are reviewed for claims of improved safety and analyzed for measuring incidence, effectiveness as NNT, adverse effects as NNH, and quantifying net benefit. The results guide the choice of maintenance fluids and also provoke future research in this area.