Original ArticleHypotonic versus Isotonic Fluids in Hospitalized Children: A Systematic Review and Meta-Analysis
Section snippets
Methods
We developed a detailed protocol for the selection of studies (available on request from the authors). Studies eligible for inclusion were clinical trials that enrolled hospitalized children aged 1 month to 18 years and compared isotonic and hypotonic IV fluids. Studies were excluded if they did not have a comparison group or only studied patients with diabetes insipidus, diabetic ketoacidosis, burns, or shock, because the former is known to involve sodium dysregulation and the latter 3 require
Results
Our initial search identified 1634 articles, which, after cross-reference and initial screening, we narrowed to 85 abstracts and full text articles. After final review and discussion, we selected 22 full text articles (Figure 1; available at www.jpeds.com). Eleven articles were identified as randomized controlled trials from which data were extracted (Table II).16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26 One article was excluded because complete results were not available, given that the article
Discussion
We found a significantly increased risk of hyponatremia in hospitalized patients receiving hypotonic fluids at maintenance rates. This risk was consistent looking at change in serum sodium and moderate hyponatremia, as well as in the subset of trials using 0.5 normal 0.45% saline as the comparison fluid. This review adds to the previous systematic review13 by including 8 additional randomized controlled trials with 777 additional subjects; the majority of these subjects were in an ICU or
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B.F. is a scholar of the Research to Advance Community Health Center. The authors declare no conflicts of interest.
Portions of this study were presented as an abstract, which received the 2013 Abstract Research Award from the American Academy of Pediatrics, Section of Hospital Medicine at the AAP National Conference & Exhibition in Orlando, FL, October 26-29, 2013.