Fluid Management

Abstract

Paediatric fluid therapy is a complex area. The unique physiology of paediatric patients presents a number of challenges that must be accounted for in prescribing fluid therapy. Paediatric fluid therapy was historically based on Holliday and Segar’s 1957 paper. However, recent evidence has advocated moving away from the hypotonic fluid recipe that was the go-to fluid therapy for maintenance fluids in children. Instead, balanced isotonic crystalloids have come into favour. This particularly reduces the risk of hyponatraemia that was commonly seen in post-op surgical patients due to non-physiologic anti-diuretic hormone release. Moreover, the perceived requirement for glucose administration to prevent hypoglycaemia may have been overstated and it is necessary only in selected patients. Colloids have yet to be shown to be superior to crystalloids, except for the selected use of albumin in patients who are vulnerable to fluid overload. Recently, there has been considerable interest in combining the above findings into an ‘ideal’ fluid but, as yet, that has not happened and the onus is on the prescribing clinician to understand and account for the relative benefits and potential harms of their fluid prescriptions.