open access

Vol 50, No 1 (2018)
Review articles
Published online: 2017-11-11
Submitted: 2017-09-27
Accepted: 2017-11-11
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Intravenous fluid therapy for hospitalized and critically ill children: rationale, available drugs and possible side effects

Thomas Langer, Rosamaria Limuti, Concezione Tommasino, Niels van Regenmortel, Els L.I.M. Duval, Pietro Caironi, Manu L.N.G. Malbrain, Antonio Pesenti
DOI: 10.5603/AIT.a2017.0058
·
Pubmed: 29151001
·
Anaesthesiol Intensive Ther 2018;50(1):49-58.

open access

Vol 50, No 1 (2018)
Review articles
Published online: 2017-11-11
Submitted: 2017-09-27
Accepted: 2017-11-11

Abstract

Human beings are constituted mainly of water. In particular, children’s total body water might reach 75–80% of their
body weight, compared to 60–70% in adults. It is therefore not surprising, that children, especially hospitalized newborns
and infants, are markedly prone to water and electrolyte imbalances. Parenteral fluid therapy is a cornerstone
of medical treatment and is thus of exceptional relevance in this patient population.
It is crucial to appreciate the fact that intravenous fluids are drugs with very different characteristics, different indications,
contraindications and relevant side effects. In the present review, we will summarize the physiology and
pathophysiology of water and electrolyte balance, underlining the importance and high prevalence of non-osmotic
antidiuretic hormone release in hospitalized and critically ill children. Furthermore, we will discuss the characteristics
and potential side effects of available crystalloids for the paediatric population, making a clear distinction between
fluids that are hypotonic or isotonic as compared to normal plasma. Finally, we will review the current clinical practice
regarding the use of different parenteral fluids in children, outlining both the current consensus on fluids employed
for resuscitation and replacement and the ongoing debate concerning parenteral maintenance fluids.

Abstract

Human beings are constituted mainly of water. In particular, children’s total body water might reach 75–80% of their
body weight, compared to 60–70% in adults. It is therefore not surprising, that children, especially hospitalized newborns
and infants, are markedly prone to water and electrolyte imbalances. Parenteral fluid therapy is a cornerstone
of medical treatment and is thus of exceptional relevance in this patient population.
It is crucial to appreciate the fact that intravenous fluids are drugs with very different characteristics, different indications,
contraindications and relevant side effects. In the present review, we will summarize the physiology and
pathophysiology of water and electrolyte balance, underlining the importance and high prevalence of non-osmotic
antidiuretic hormone release in hospitalized and critically ill children. Furthermore, we will discuss the characteristics
and potential side effects of available crystalloids for the paediatric population, making a clear distinction between
fluids that are hypotonic or isotonic as compared to normal plasma. Finally, we will review the current clinical practice
regarding the use of different parenteral fluids in children, outlining both the current consensus on fluids employed
for resuscitation and replacement and the ongoing debate concerning parenteral maintenance fluids.

Get Citation

Keywords

paediatric critical care; paediatric anaesthesia; intravenous fluids, crystalloids; acid-base equilibrium

About this article
Title

Intravenous fluid therapy for hospitalized and critically ill children: rationale, available drugs and possible side effects

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 50, No 1 (2018)

Pages

49-58

Published online

2017-11-11

DOI

10.5603/AIT.a2017.0058

Pubmed

29151001

Bibliographic record

Anaesthesiol Intensive Ther 2018;50(1):49-58.

Keywords

paediatric critical care
paediatric anaesthesia
intravenous fluids
crystalloids
acid-base equilibrium

Authors

Thomas Langer
Rosamaria Limuti
Concezione Tommasino
Niels van Regenmortel
Els L.I.M. Duval
Pietro Caironi
Manu L.N.G. Malbrain
Antonio Pesenti

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