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Administration of hypotonic solutions vs. isotonic solutions in hospitalized children.

Article Excerpt
The Evidence Summarized and Leveled

Study 1. Findings from a meta-analysis that included 6 randomized controlled trials indicated that hypotonic solutions (less than 0.9% NS) significantly increased the risk of developing acute hyponatraemia over isotonic (0.9% NS or Ringers Lactate) solutions. Overall treatment effect--Odds of hyponatremia after hypotoninc solution are 17.2 times greater than with isotonic fluid (95% CI 8.67 to 34.2), and result in greater patient morbidity. Six studies met inclusion criteria in this meta-analysis. Limitations--The 6 studies had heterogeneous designs, small samples of variable quality (only 2 RCTs), and did not consider confounding factors, such as mixed populations (included surgical and non-surgical, majority are postoperative) (Level 1) (Choong, Kho, Menon, & Bohn, 2006). Nonetheless, systematic reviews are the strongest to guide practice.

Study 2. Hospitalized children who developed hyponatremia received more electrolyte-free water and had a higher positive water balance than those who did not develop hyponatremia. This group also received fluid amounts that were above recommended maintenance requirements. This retrospective, case-control study with a convenience sample (N = 40) did not have an adequate sample size to enable statistical judgments that are accurate and reliable (the study did not have adequate power). It included surgical and non-surgical patients. Cases were matched on age, gender, and weight,...

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