• Anwarul Haque
  • Sadiq Mirza
  • Sidra Kaleem Jafri
  • Faizia Naseem
  • Khalid Mahmood Khan
  • Muhammad Faheem Afzal
  • Muhammad Haroon Hamid


Background: Isotonic saline is recommended as maintenance intravenous fluid therapy (MIVFT) for most of the acutely ill hospitalized children.  The aim of this study is to assess the current knowledge of paediatric residents regarding the selection of MIVFT in hospitalized children. Methods: We conducted a paper-based questionnaire survey to paediatric residents from ten centres asking selection of MIVFT in four common clinical scenarios in 6-month and 10-year old patients as well as monitoring of fluid balance and electrolyte. Results: 445 responses were collected (>90% response rate). Majority [78.3% (n=348)] of them were FCPS-trainees. The 0.9%, 0.45% and 0.2% solution were selected by 45.8%, 43.98% and 10.92% respectively. The isotonic and hypotonic solution was prescribed in 6-mo (35.22% vs. 64.76% [p<0.001]) and 10-year (54.49% vs. 44.98%) in four different clinical scenarios respectively. 0.45% solution was most commonly prescribed MIVFT in pneumonia (50.22%) and meningitis (45.39%) and 0.9% solution was most commonly selected in acute gastroenteritis (55.05%) and post-operative patients (51.23%). Fluid balance and electrolyte monitoring were selected by 96.9% and 55.7% respondents respectively. Conclusion: Our survey reports that more than fifty percent of paediatric residents have inadequate knowledge about maintenance intravenous fluid therapy in acutely ill hospitalized children.Keywords:  Children, maintenance intravenous fluid, knowledge, residents


Choong K, Bohn D. Maintenance parenteral fluids in the critically ill child. J Pediatr (Rio J) 2007;83:S3–10.

Cavari Y, Pitfield AF, Kissoon N. Intravenous maintenance fluids revisited. Pediatr Emerg Care 2013;29(11):1225–8.

Moritz ML, Ayus JC. Prevention of hospital-acquired hyponatremia: a case for using isotonic saline. Pediatrics 2003;111(2):227–30.

Kaneko K. Hospital-acquired hyponatremia in children: Epidemiology, pathophsiology, and prevention. J Pediatr Biochem 2010;1:39–44.

Hoorn EJ, Geary D, Robb M, Halperin ML, Bohn D. Acute hyponatremia related to intravenous fluid administration in hospitalized children: an observational study. Pediatrics 2004;113(5):1279–84.

Moritz ML, Ayus JC. New aspects in the pathogenesis, prevention, and treatment of hyponatremic encephalopathy in children. Pediatr Nephrol 2010;25(7):1225–38.

Moritz ML, Ayus JC. Hospital-acquired hyponatremia--why are hypotonic parenteral fluids still being used? Nat Clin Pract Nephrol 2007;3(7):374–82.

Moritz ML, Ayus JC. Intravenous fluid management for the acutely ill child. Curr Opin Pediatr 2011;23(2):186–93.

Beck CE. Hypotonic versus isotonic maintenance intravenous fluid therapy in hospitalized children: a systematic review. Clin Pediatr (Phila) 2007;46(9):764–70.

Wang J, Xu E, Xiao Y. Isotonic versus hypotonic maintenance IV fluids in hospitalized children: a meta-analysis. Pediatrics 2014;133(1):105–13.

Foster BA, Tom D, Hill V. Hypotonic versus Isotonic Fluids in Hospitalized Children: A Systematic Review and Meta-Analysis. J Pediatr 2014;165(1):163–9.

Choong K, Arora S, Cheng J, Farrokhyar F, Reddy D, Thabane L, et al. Hypotonic versus isotonic maintenance fluids after surgery for children: a randomized controlled trial. Pediatric 2011;128(5):857–66.

Freeman MA, Ayus JC, Moritz ML. Maintenance intravenous fluid prescribing practices among paediatric residents. Acta Paediatr 2012;101(10):e465–8.

Lee JM, Jung Y, Lee SE, Lee JH, Kim KH, Koo JW, et al. Intravenous fluid prescription practices among pediatric residents in Korea. Korean J Pediatr 2013;56(7):282–5.