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Case Reports
. 2021 Jun 7;15(1):315.
doi: 10.1186/s13256-021-02889-0.

From hypotonic maintenance fluid to severe hyponatremia: a case report

M Denis  1   2   3   4 , A Di Giacomo  5 , E Lacotte  5   6   7 , F Porcheret  5   8 , N Letouzé  5 , B Lauzier  9 , I Goyer  10 , D Brossier  5   11
Affiliations
Case Reports

From hypotonic maintenance fluid to severe hyponatremia: a case report

M Denis et al. J Med Case Rep. .

Abstract

Background: The principles for maintenance intravenous fluid prescription in children were developed in the 1950s. These guidelines based on the use of hypotonic solutions have been challenged regularly for they seem to be associated with an increased risk of hospital-acquired hyponatremia.

Case presentation: We report the case of a 4-week-old Caucasian child admitted for acute bronchiolitis who received hypotonic maintenance fluids and developed severe hyponatremia (94 mmol/L) with hyponatremic encephalopathy.

Conclusion: This clinical situation can serve as a reminder of the latest recommendations from the American Academy of Pediatrics regarding the use of intravenous fluids that promote the use of isotonic fluids in children.

Keywords: Hyponatremia; Hypotonic fluid; Intensive care; Isotonic fluid.

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Conflict of interest statement

The authors declare that they have no competing interest to disclose.

Figures

Fig. 1
Fig. 1
Chest X-ray upon admission to the pediatric ward
Fig. 2
Fig. 2
Natremia and diuresis over time before and after PICU admission. h: hours; NaCl 3%: hypertonic solution NaCl 3% (3 mL/Kg); desmopressin (0.1 mg/kg); NaCl 0.2%: maintenance intravenous fluid containing 2 g/L of NaCl; NaCl 0.6%: maintenance intravenous fluid containing 6 g/L of NaCl; NaCl 0.9%: maintenance intravenous fluid containing 9 g/L of NaCl
Fig. 3
Fig. 3
Cerebral tomodensitometry depicting widespread cerebral edema
Fig. 4
Fig. 4
Tomodensitometry and three-dimensional (3D) reconstruction of the subglottic stenosis
See this image and copyright information in PMC

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