Maintenance Fluid therapy_2018 Guidelines

1.Maintenance intravenous fluids are needed (if sufficient enteral fluids cannot be provided due to illness/other reasons) to preserve the extracellular volume, prevent depletion of intravascular volume, and minimize the risk of hypo/hypernatremia,

2.The osmolarity of plasma is 308 mOsm/L. Osmolarity calculations for IV fluids usually exclude the dextrose in the solution because dextrose is rapidly metabolized in solution.

3.Hypotonic fluids for maintenance therapy result in a high incidence of hyponatremia. Hypotonic fluids include N/5 (0.2%) NaCI with 5% dextrose (Osmolarity 78 mOsm/L), and N/2 (0.45%) NaCI with 5% dextrose (Osmolarity 154 mOsm/L).

4 Patients between 28 days to 18 years of life should receive isotonic fluid for maintenance fluid therapy with appropriate potassium chloride and dextrose, to reduce the risk of developing hyponatremia. NaCI 0.9 % with 5% dextrose (308 mOsm/L) is an isotonic IV fluid. Ringer lactate with 5% dextrose (273 mOsm/L) is near isotonic.

5.These guidelines applies to children in surgical (postoperative) and medical acute care settings, including critical care and the general inpatient ward. 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.

Piyush Gupta MD, FIAP, FNNF, FAMS
Professor of Pediatrics

University College of Medical Sciences; 

New Delhi - 110 095, India.

Reference: Clinical Practice Guideline: Maintenance Intravenous Fluids in Children. American Academy of Pediatrics. Pediatrics 2018;142:e20183083. To read full text, click:

 http://pediatrics.aappublications.org/content/pediatrics/early/2018/11/21/peds.2018-3083.full.pdf

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