Effect of Isotonic and Hypotonic Fluid Therapy on Serum Sodium: A Randomized Controlled Trial
There is little consensus about the type of maintenance fluid therapy and it’s the effect on serum sodium in adults. Thus, this study was conducted to assess the effect of maintenance fluid therapy on serum sodium of hospitalized patients in the intensive care unit. This randomized clinical trial was carried out on 64 patients aged 18-90 years hospitalized in the intensive care unit (ICU) of Imam Sadjad and Shahid Beheshti hospitals, Yasuj, Iran, in 2017. These patients were randomly allocated to take 2500-3000 milliliters of intravenous maintenance isotonic (0.9% saline) or hypotonic (0.45% saline) fluids daily. Blood and urine samples were taken to measure biochemical parameters before and 48 hours after the intervention. Data analyses were done by using SPSS 16 software via descriptive and analytic statistics. Twenty-eight patients in the 0.9% saline group (19 male and 9 female) and 32 patients in 0.45% saline (20 male and 12 female) completed the study. There was no significant difference between two groups in sodium (P=0.94), potassium (P=0.21), sugar (P=0.91), creatinine (P=0.21), Blood Urea Nitrogen (P=0.99), systolic (P=0.81) and diastolic (P=0.73) blood pressure, PH (P=0.27), bicarbonate (P=0.8), and urine specific gravity (P=0.73). Based on the results of this study, it was shown that the administration of maintenance hypotonic fluids has been appropriate for the patients and will not face them with the risk of hyponatremia.
2- Nielsen S. Molecular Physiology of Water Balance. New England Journal of Medicine. 2015; 372: 1349-58.
3-Danziger J، Zeidel ML. Osmotic homeostasis. Clinical journal of the American Society of Nephrology: CJASN. 2015; 10: 852-62.
4-Schrier RW. Body water homeostasis: clinical disorders of urinary dilution and concentration. Journal of the American Society of Nephrology: JASN. 2006; 17 : 1820-32
5- Ayus JC، Wheeler JM، Arieff AI. Postoperative hyponatremic encephalopathy in menstruant women. Annals of internal medicine. 1992; 117: 891-7.
6-Carandang F، Anglemyer A، Longhurst CA، Krishnan G، Alexander SR، Kahana M، et al. Association between maintenance fluid tonicity and hospital-acquired hyponatremia. The Journal of pediatrics. 2013;163: 1646-51.
7-Steele A، Gowrishankar M، Abrahamson S، Mazer CD، Feldman RD، Halperin ML. Postoperative hyponatremia despite near-isotonic saline infusion: a phenomenon of desalination. Annals of internal medicine. 1997; 126: 20-5.
8-Nigro N، Winzeler B، Suter-Widmer I، Schuetz P، Arici B، Bally M، et al. Symptoms and characteristics of individuals with profound hyponatremia: a prospective multicenter observational study. Journal of the American Geriatrics Society. 2015; 63: 470-5.
9- al JWe. Isotonic versus Hypotonic Maintenance IV Fluids in Hospitalized Children: A Meta -Analysis. American Academy of Pediatrics. 2013; 133:
10- Valadao MC، Piva JP، Santana JC، Garcia PC. Comparison of two maintenance electrolyte solutions in children in the postoperative appendectomy period: a randomized، controlled trial. Jornal de pediatria. 2015; 91:428-34.
11- Friedman JN، Beck CE، DeGroot J، Geary DF، Sklansky DJ، Freedman SB. Comparison of isotonic and hypotonic intravenous maintenance fluids: a randomized clinical trial. JAMA pediatrics. 2015; 169:445-51.
12- Yung M، Keeley S. Randomized controlled trial of intravenous maintenance fluids. Journal of pediatrics and child health. 2009; 45:9-14.
13- Saba TG، Fairbairn J، Houghton F، Laforte D، Foster BJ. A randomized controlled trial of isotonic versus hypotonic maintenance intravenous fluids in hospitalized children. BMC pediatrics. 2011; 11:82.
14-Ramanathan S، Kumar P، Mishra K، Dutta AK. Isotonic versus Hypotonic Parenteral Maintenance Fluids in Very Severe Pneumonia. Indian journal of pediatrics. 2016; 83:27-32.
15- Friis-Hansen BJ: Body water compartments in children: changes during growth and related changes in body composition. Pediatrics 1961; 28: 169–181.
16-Moritz ML، Ayus JC. Hospital-acquired hyponatremia--why are hypotonic parenteral fluids still being used? Nature clinical practice Nephrology. 2007; 3:374-82.
17- Foster BA، Tom D، Hill V. Hypotonic versus isotonic fluids in hospitalized children: a systematic review and meta-analysis. The Journal of pediatrics. 2014; 165:163-9. e2.
18- 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: 1279-84.
19- Eulmesekian PG، Pérez A، Minces PG، Bohn D. Hospital-acquired hyponatremia in postoperative pediatric patients: prospective observational study. Pediat Crit Care Med. 2010;11: 479-83.
20- Neville KA، Sandman DJ، Rubinstein A، Henry GM، McGlynn، Walker JL. Prevention of hyponatremia during maintenance intravenous fluid administration: a prospective randomized study of fluid type versus fluid rate. J Pediatric. 2010; 156، 313-9.e1-2.
21-Shamim A، Afzal K، Ali SM. Safety and efficacy of isotonic (0.9%) vs. hypotonic (0.18%) saline as maintenance intravenous fluids in children: a randomized controlled trial. Indian pediatrics. 2014; 51:969-74.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.