Neurological complications from dysnatremias in children: a different point of view
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In a recent review article, Moritz and Ajus  have suggested that the routine administration of hypotonic fluids, as proposed by Holliday et al. , can result in fatal hyponatremic encephalopathy. To support this statement they discussed the death of a 3-week-old child who was treated in the setting of dehydration with a bolus of 0.9% NaCl followed by maintenance hypotonic fluids. They also cited the death of 16 children who developed severe hyponatremia due to extensive extra renal losses of electrolyte-containing fluids, and were not treated in a timely manner even in the presence of obvious symptoms . It appears that Moritz and Ajus have misinterpreted the teachings of Holliday et al. . Holliday et al. recommended the use of hypotonic fluids to replace ongoing physiological insensible and urinary water losses when oral intake is suspended under well-defined clinical conditions . They defined the term 'maintenance therapy', and clarified that (1) the formula...
KeywordsSerum Sodium Hypertonic Saline Serum Sodium Concentration Maintenance Fluid Severe Hyponatremia