The risk for hyponatraemia may be increased with use of solutions containing very low sodium in paediatric patients, in comparison with fluids with a sodium content of 75–150 mmol/litre. Solutions containing low sodium, such as 0.18% sodium chloride with 4% glucose, or 5% glucose in water, should not be used for rehydration or fluid maintenance. Appropriate sodium-containing IV maintenance fluids should contain glucose to avoid hypoglycaemia and starvation ketosis in children who are unable to feed orally or by nasogastric tube.
Children who are severely dehydrated or with signs of shock should be resuscitated with isotonic IV solutions (normal saline 0.9% or Ringer’s lactate).
Intravenous maintenance fluid:
Children who require IV fluids for maintenance should be managed with Ringer’s lactate solution with 5% dextrose or 0.9% normal saline with 5% glucose or half-normal saline (0.45% sodium chloride) with 5% glucose.