Recent literature has emerged in which researchers describe the context-dependent use of IVFs, which should be prescribed, ordered, dosed, and delivered like any other drug. Guidelines for maintenance IVF therapy in children have primarily been opinion based, and evidence-based consensus guidelines are lacking. Concerns have been raised that this approach results in a high incidence of hyponatremia and that isotonic IVF could prevent the development of hyponatremia. The administration of hypotonic IVF has been the standard in pediatrics. Because maintenance IVFs may have both potential benefits and harms, they should only be administered when clinically indicated.

For the purposes of this document, specifying appropriate maintenance IVFs includes the composition of IVF needed to preserve a child’s extracellular volume while simultaneously minimizing the risk of developing volume depletion, fluid overload, or electrolyte disturbances, such as hyponatremia or hypernatremia. IVFs are required if sufficient fluids cannot be provided by using enteral administration for reasons such as gastrointestinal illness, respiratory compromise, neurologic impairment, a perioperative state, or being moribund from an acute or chronic illness. Maintenance intravenous fluids (IVFs) are used to provide critical supportive care for children who are acutely ill. The Key Action Statement of the subcommittee is as follows:ġA: The American Academy of Pediatrics recommends that patients 28 days to 18 years of age requiring maintenance IVFs should receive isotonic solutions with appropriate potassium chloride and dextrose because they significantly decrease the risk of developing hyponatremia (evidence quality: A recommendation strength: strong)

We specifically address the tonicity of maintenance IVFs in children. Patients with neurosurgical disorders, congenital or acquired cardiac disease, hepatic disease, cancer, renal dysfunction, diabetes insipidus, voluminous watery diarrhea, or severe burns neonates who are younger than 28 days old or in the NICU and adolescents older than 18 years old are excluded. This guideline applies to children in surgical (postoperative) and medical acute-care settings, including critical care and the general inpatient ward. Our goal in this guideline is to provide an evidence-based approach for choosing the tonicity of maintenance IVFs in most patients from 28 days to 18 years of age who require maintenance IVFs. Concerns have been raised that this approach results in a high incidence of hyponatremia and that isotonic IVFs could prevent the development of hyponatremia. The administration of hypotonic IVFs has been the standard in pediatrics. Despite the common use of maintenance IVFs, there is high variability in fluid prescribing practices and a lack of guidelines for fluid composition administration and electrolyte monitoring.

Neonatal maintenance fluid calculator