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PEDIATRICS Vol. 113 No. 5 May 2004, pp. 1395-1396

COMMENTARY

Hospital-Acquired Hyponatremia: Why Are There Still Deaths?

Michael L. Moritz, MD and Juan Carlos Ayus, MD

Division of Nephrology, Department of Pediatrics, Children’s Hospital of Pittsburgh, University of Pittsburgh School Medicine, Pittsburgh, PA 15213-2538
Department of Medicine, University of Texas Health Science Center, San Antonio, TX 78229-3900

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Intravenous fluids are probably the most frequently prescribed medication for hospitalized children. The current practice of administering hypotonic fluids to children is based largely on recommendations of Holliday and Segar,1 made almost 50 years ago and on their assumption that the electrolyte composition of intravenous fluids should approximate the composition of human and cow milk. The safety of these recommendations has never been established. There have been >50 cases of death or permanent neurologic injury in children over the past decade from hospital-acquired hyponatremia resulting from the administration of hypotonic fluid.2–5 In a recent contribution to Pediatrics, we introduced the . . . [Full Text of this Article]

Address correspondence to Michael L. Moritz, MD, Division of Nephrology, Children’s Hospital of Pittsburgh, 3705 Fifth Ave, Pittsburgh, PA 15213-2538. E-mail: michael.moritz@chp.edu


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