Maintenance intravenous fluid prescribing practices among paediatric residents

Abstract

Aim: To investigate the sodium composition of maintenance intravenous fluids (mIVF) used by paediatric residents throughout the United States in common clinical scenarios of arginine vasopressin (AVP) excess.

Methods: We distributed an online survey to paediatric residency programmes asking what type of mIVF (0.2%, 0.45%, 0.9% NaCl or lactated Ringer's solution) they would administer in four common clinical scenarios of AVP excess (gastroenteritis, pneumonia, meningitis and postoperative) in both a 6-month-old (mo) and a 13-year-old (yo) child.

Results: We had 472 responses, representing 5% of the total paediatric residency population in the United States. Hypotonic mIVF were selected in 78% of children (88.2% of 6 mo and 68.5% of 13 yo). Isotonic mIVF were selected approximately twice as often for patients with meningitis as for those without (21.4% vs. 8.7% 6 mo and 42.8% vs. 27.7% 13 yo; p < 0.001).

Conclusions: The majority of US paediatric residents would prescribe hypotonic mIVF in disease states associated with AVP excess. However, a significant number of residents are using isotonic mIVF. Isotonic fluids are more likely to be prescribed in older children and children with meningitis.

Fig. 1

Fluid selected by respondents in each clinical scenario for the 6 month-old infant. The respondents predominantly selected hypotonic fluids in all cases. They were significantly more likely to select isotonic fluids in patients with meningitis as compared to all other cases. (p <0.001)

Fig. 2

Fluid selected by respondents in each clinical scenario for the 13 year-old child. The respondents predominantly selected hypotonic fluids in all cases. They were significantly more likely to select isotonic fluids in patients with meningitis as compared to all other cases. (p <0.001)