Affiliations: Department of Pediatrics, Kansai Medical University,
2-3-1 Shin-machi, Hirakata-shi, Osaka 573-1191, Japan. Tel.: +81 72 804 0101;
Fax: +81 72 804 2928; E-mail: kanekok@hirakata.kmu.ac.jp
Abstract: Recent observations have revealed that otherwise healthy children
with acute illnesses are prone to hyponatremia due to increased arginine
vasopressin production by non-osmotic stimuli. Concern has recently been raised
about the potential for iatrogenic hyponatremia as a result of maintenance
fluid therapy for those children. To minimize the risk of development of
hospital-acquired hyponatremia in sick children receiving maintenance fluid
therapy, the routine practice of administration of hypotonic fluids (e.g.,
0.18% NaCl with 4% glucose: Na 31 mEq/L, Cl 31 mEq/L) should be
abandoned. Instead, isotonic solution, such as 0.9% NaCl (Na 154 mEq/L, K 0
mEq/L, Cl 154 mEq/L) or Hartmann's solution (Na 130 mEq/L, K 4 mEq/L, Cl 110
mEq/L) should be administered. In addition, it must be noted that close
monitoring of the children with daily weights, frequent vitals, strict intake
and output measurement, and daily chemistries, especially during the first 72 h
of parenteral fluid therapy is essential.