A safe solution

The letter from Sanchez‐Bayle et al,¹ partially describing a study on the administration of hypotonic intravenous fluids adds little to the safety of childrens receiving intravenous fluids. The deaths of at least 50 children attributable to the administration of hypotonic intravenous fluids in clinical settings, associated with increased circulating levels of antidiuretic hormone, have been described. Typically, these are previously healthy children with gastroenteritis or in the postoperative phase after minor surgical procedures.² At least six or seven children have died in the UK in this manner within the past 5 years,³ with some of these deaths currently being investigated by the Police Service of Northern Ireland.

Although the routine prescription of hypotonic intravenous fluids may be safe if the volumes administered are tightly restricted, and with close plasma electrolyte and fluid balance monitoring, the fact is that around the world, we have demonstrated that in clinical practice we are unable to give these fluids in such a manner, resulting in the needless deaths of previously healthy children.

Furthermore, there is absolutely no advantage in routinely giving a fluid with tonicity below that of 0.45% saline, and certain high‐risk groups, such as those with established hyponatraemia, gastroenteritis or in the postoperative state, should only ever receive isotonic fluids. The use of isotonic fluids such as sodium chloride 0.9% with glucose 5% will adequately deal with “maintenance” glucose requirements in most children.

Given the clear dangers associated with the routine administration of the most hypotonic intravenous fluids, and given the clear lack of advantage in their use, I am surprised that Sanchez‐Bayle et al's study was granted ethical approval. Deaths because of this mechanism are rare, and I will be interested to see how many thousands of children these authors intend to study to show the safety of sodium chloride 0.3% with glucose 5% in this setting.