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Isotonic versus Hypotonic Parenteral Maintenance Fluids in Very Severe Pneumonia

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Abstract

Objective

To compare the risk of hyponatremia between hypotonic and isotonic parenteral maintenance solutions (PMS) administered to children with very severe pneumonia, admitted in the general pediatric ward.

Methods

A randomized controlled open label trial was conducted in the pediatrics department of a tertiary care medical college hospital including euvolemic children 2 mo to 5 y of age, fulfilling the WHO clinical definition of very severe pneumonia and requiring PMS. They were randomized to receive either isotonic PMS (0.9 % saline in 5 % dextrose and potassium chloride 20 meq/L) or hypotonic PMS (0.18 % saline in 5 % dextrose and potassium chloride 20 meq/L) at standard rates for next 24 h.

Results

A total of 119 children were randomized (59: Isotonic; 60: Hypototonic PMS). Nine (15 %) children in the isotonic PMS group and 29 (48 %) in the hypotonic PMS group developed hyponatremia during the study period, (p <0.001) with a relative risk being 3.16 (95 % CI 1.64 to 6.09). Mean serum sodium was significantly lower in the hypotonic group compared to the isotonic group (p < 0.001 each at 6, 12 and 24 h). The difference in mean change in serum sodium from baseline was also significant at 12 and 24 h (5.4 and 5.8 meq/L respectively; p < 0.001 each).

Conclusions

This study demonstrates the rationality of the use of isotonic PMS in children with respiratory infections, a condition regularly encountered by most pediatricians.

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Contributions

RS: Collected data and wrote the primary draft of the article; KM: Supervised the research, analysed the data and wrote the final article; PK and AKD: Conceptualized and designed the study, gave critical inputs and approved the final version of the article. AKD will act as guarantor for this paper.

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Authors and Affiliations

  1. Department of Pediatrics, Lady Hardinge Medical College, Kalawati Saran Children’s Hospital, New Delhi, 110001, India

    Subramaniam Ramanathan, Praveen Kumar, Kirtisudha Mishra & Ashok Kumar Dutta

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  1. Subramaniam Ramanathan
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  2. Praveen Kumar
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  3. Kirtisudha Mishra
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  4. Ashok Kumar Dutta
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Corresponding author

Correspondence to Kirtisudha Mishra.

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Ramanathan, S., Kumar, P., Mishra, K. et al. Isotonic versus Hypotonic Parenteral Maintenance Fluids in Very Severe Pneumonia. Indian J Pediatr 83, 27–32 (2016). https://doi.org/10.1007/s12098-015-1791-6

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  • DOI: https://doi.org/10.1007/s12098-015-1791-6

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