A4.1 Choice of intravenous fluids

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.

Resuscitation:

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.