Na+

(mmol/L)

Cl‐

(mmol/L)

K+

(mmol/L)

Mg++

(mmol/L)

Calcium

(mmol/L)

Lactate

(mmol/L)

Acetate

(mmol/L)

Gluconate

(mmol/L)

Glucose

(gram/L)

Physiologically isotonic/near isotonic

0.9% sodium chloride

154

154

‐

‐

‐

‐

‐

‐

‐

0.9% sodium chloride with 2.5/5% dextrose

154

154

‐

‐

‐

‐

‐

‐

25 / 50

Hartmann's solution (similar in ionic composition to Ringer's lactate)

131

111

5

‐

2

29

‐

‐

‐

Plasmalyte 148 solution

140

98

5

1.5

‐

‐

27

23

‐

Plasmalyte 148 solution with 5% dextrose

140

98

5

1.5

‐

‐

27

23

50

Physiologically moderately hypotonic

0.45% sodium chloride (N/2) with 5% dextrose  

77

77

‐

‐

‐

‐

‐

‐

50

Physiologically very hypotonic

0.3% sodium chloride (N/3) with 3.3% dextrose

51

51

‐

‐

‐

‐

‐

‐

33

0.18% sodium chloride (N/5) with 4% dextrose

30

30

‐

‐

‐

‐

‐

‐

40

Study

Number of participants

Population

Study arms

Primary outcome

Brazel 1996

12

Patients undergoing primary corrective surgery for idiopathic scoliosis

Isotonic (Hartmann's)

Hypotonic (either 0.3% saline + 3% dextrose or 0.18% saline + 4% dextrose)

Rate: 1.5 ml/kg/hr

Development of SIADH

Montañana 2008

122

PICU patients

Isotonic fluid (sodium 140 mEq/L)

Hypotonic fluid (sodium between 20 and 100 mEq/L corresponding to 2 to 4 mEq/kg/24 hr)

Exact composition of fluids not stated

Rate: standard maintenance

Hyponatraemia < 135 mEq/L

Yung 2009

50

PICU patients

0.9% saline at standard maintenance rate

0.9% saline at 2/3 restricted rate

0.18% saline + 4% dextrose at standard maintenance rate

0.18% saline + 4% dextrose at 2/3 restricted rate

Change in plasma sodium from admission to 12 to 24 hrs later

Kannan 2010

167

Broad paediatric population (university hospital in India)

0.9% saline + 5% dextrose at standard maintenance rate

0.18% saline + 5% dextrose at standard maintenance rate

0.18% saline + 5% dextrose at 2/3 restricted rate

Hyponatraemia < 130mEq/L

Neville 2010

124

Elective or emergency surgery

0.9% saline + 2.5% dextrose at standard maintenance rate

0.9% saline + 5% dextrose at 50% restricted rate

0.45% saline + 2.5% dextrose at standard maintenance rate

0.45% saline + 5% dextrose at 50% restricted rate

Change in plasma sodium from induction of anaesthesia to T8

Rey 2011

125

PICU patients

Isotonic (sodium 136 mmol/L)

Hypotonic (sodium 30 to 50 mmol/L)

Exact composition not stated

Rate: standard maintenance

Change in plasma sodium from admission to 12 and 24 hrs later

Choong 2011

258

Surgical patients

0.9% saline + 5% dextrose

0.45% saline + 5% dextrose

Rate: Physician's discretion

Hyponatraemia < 135 mmol/L

Saba 2011

37

Medical patients admitted via ED

Elective surgical patients

0.9% saline + 5% dextrose

0.45% saline + 5% dextrose

Rate: physician's discretion

Rate of change of sodium

Coulthard 2012

82

Patients undergoing spinal instrumentation, craniotomy for brain tumour resection or cranial vault remodelling

Hartmann's + 5% dextrose at full maintenance rate

0.45% saline + 5% dextrose at 2/3 restricted rate

Mean plasma sodium 16 to 18 hrs postoperatively

Cuello 2012

(abstract only)

72

Participants with either of 2 conditions:

a) gastroenteritis with moderate dehydration and unable to tolerate fluids

b) children requiring non‐urgent surgery and requiring maintenance intravenous hydration during their admission

0.9% saline + 5% dextrose +/‐ 20 mmol/L KCl

0.2% saline + 5% dextrose +/‐ 20 mmol/L KCl

Rate: standard maintenance

Mean plasma sodium at 4 (T4) and 8 (T8) hours, and the percentage of patients who developed hyponatraemia (> 125 mEq/L and < 135 mEq/L)

First author

Duration of fluid therapy

Timing of outcome measurements

Brazel

Max 72 hrs

End of procedure, T6, T24, T48, T72

Montañana

Max 24 hrs

T6, T24 (only T6 primary outcome data included in analysis)

Yung

12 to 24 hrs

T12 to 24

Kannan

Max 72 hrs

T12, T24, T36, T48, T60, T72

Neville

Max 24 hrs

At intubation, T8, T24

Rey

Max 24 hrs

T12, T24

Choong

Max 48 hrs

T12, T24, T36, T48

Saba

8 to 12 hrs

T12

Coulthard

16 to 18 hrs

T16 to 18

Cuello

8 hrs

T4, T8

Primary author

Inclusion criteria

Exclusion criteria

Brazel

Adolescent patients undergoing primary corrective surgery for adolescent idiopathic scoliosis

—

Montañana

PICU patients requiring maintenance intravenous fluid

Chronic or acute kidney failure

Patients at risk of cerebral oedema (diabetic ketoacidosis or craneoencephalic trauma)

Patients with plasma sodium level at admission < 130 mEq/L or > 150 mEq/L, and/or dehydration > 5% of the patient's body weight

Yung

Patients admitted to PICU who would normally require IV fluids at standard maintenance rates for 12 hrs, with normal sodium levels and not hypoglycaemic

Neonates, diabetes, renal failure, shock

Cardiac and neurosurgical patients were eligible for the restricted rate arm only

Kannan

Patients aged between 3 months and 12 years requiring IV maintenance fluid administration for at least 24 hrs

Na < 130mEq/L, Na > 150mEq/L, blood glucose > 180 mg/dL, dehydration, shock, severe malnutrition, cirrhosis of liver, congestive heart failure, acute or chronic renal failure and nephrotic syndrome

Patients receiving drugs that may alter plasma sodium levels

Patients requiring fluid boluses for volume depletion and/or shock

Neville

Patients undergoing elective or emergency surgery, expected to take nothing by mouth after surgery for at least 8 hrs. Weight > 8kg

Significant blood loss expected during surgery

Surgery types known to be associated with excess ADH secretion (cranial and thoracic surgery)

Known abnormality of ADH secretion, nephrogenic diabetes insipidus, pituitary or hypothalamic disease, kidney disease, acute or chronic lung disease

Patients receiving drugs known to stimulate ADH secretion

Rey

PICU patients requiring maintenance IV fluids

Impairment in body water homeostasis (e.g. congestive heart failure)

Electrolytic alterations requiring a different IV fluid than that in the study

Renal function abnormalities

Patients requiring fluid restriction
Patients receiving enteral or parenteral nutrition 

Choong

Euvolaemic patients within 6 hours after elective surgery if anticipated need for IV maintenance was > 24 hours

Uncorrected plasma sodium level abnormalities before the end of surgery

Patients with known abnormalities of ADH secretion

Patients requiring volume resuscitation and/or vasoactive infusions

Recent loop diuretic use

Total parenteral nutrition required with 24 hours following surgery

Patients for whom either a hypotonic or isotonic Isotonic fluid was considered necessary or contraindicated (e.g. because of a risk of cerebral oedema, acute burns or the risk of third space and/or sodium overload in patients with pre‐existing congestive cardiac failure, renal failure, liver failure or cirrhosis) 

Saba

Patients requiring at least 8 hours of IV fluids

Baseline Na of < 133 or > 145 mmol/L

Patients with any of renal disease, cardiac dysfunction, pre‐existing hypertension, diuretic use, oedema, known adrenal dysfunction, acute or severe chronic neurological illness 

Coulthard

Patients admitted to PICU following spinal instrumentation for correction of scoliosis, craniotomy for excision of brain tumours and cranial vault remodelling

Lengthening only of spinal instrumentation rods, insertion or revision of ventriculoperitoneal shunts, intracerebral cyst fenestration or previously enrolled 

Cuello

Patients 6 months to 14 years old; with a serum sodium level between 125 mmol/L to 150 mmol/L; previously healthy, admitted to the emergency room or hospitalisation ward with any of 2 conditions: a) gastroenteritis with moderate dehydration and unable to drink fluids; b) children undergoing non‐urgent surgery and requiring maintenance IV hydration during their hospitalisation (i.e. non‐incarcerated hernia, adenotonsillectomies, tympanostomy, fracture reductions of the extremities, etc.) 

Chronic illnesses (e.g. cystic fibrosis, cerebral palsy, etc.); taking antidiuretics; major trauma that required intensive care; hyper or hyponatraemia at admission; severe dehydration