AAP: The principles of pediatric fluid therapy management

Aaron Friedman, MD, reviewed maintenance and rehydration fluid therapy in the pediatric setting, as well as treatment management scenarios for common electrolyte abnormalities, at the American Academy of Pediatrics 2008 National Conference and Exhibition in Boston.

Friedman, from the University of Minnesota's Children Hospital Fairview, emphasized the importance of never using maintenance therapy as restoration fluid. Nor should maintenance therapy be used as an ongoing losses replacement or as a volume expansion solution, he said.

Another point was to consider using normal saline instead of maintenance fluid therapy for intraoperative and immediate post-operative fluid therapy and volume restoration, to prevent hyponatremia. In addition, when delivering IV therapy for the treatment of hypovolemia/hyponatremia, Friedman advised to rapidly restore extracellular fluid losses first, and then consider oral treatment and maintenance needs.

Friedman's talk also featured informal audience polls, which asked questions about specific treatment decisions for hypovolemia, hyponatremia, and hypernatremia. In the first poll, 79% of respondents in attendance said they would use IV therapy for the initial treatment of hypovolemia/hyponatremia, whereas 21% said they would use oral therapy. Friedman said that both can be used.

A second informal audience poll asked what the daily maximum amount of sodium level change should be, after repairing volume depletion during treatment of hypovolemia/hypernatremia. Sixteen percent of respondents said they would not exceed 5 mEq, 77% said they would not exceed 10 mEq, and 7% said they would not exceed 20 mEq. Friedman noted that only an amount up to and including 10 mEq would be safe. He stressed that serum sodium levels cannot be changed rapidly.