eLetters to:

ARTICLE: Kristen A. Neville, Charles F. Verge, Matthew W. O'Meara, and Jan L. Walker High Antidiuretic Hormone Levels and Hyponatremia in Children With Gastroenteritis Pediatrics 2005; 116: 1401-1407 [Abstract] [Full text] [PDF]

eLetters: Submit a response to this article

eLetters published:

Rapid Correction of Dehydration with Isotonic Saline Solution

Steve Piecuch, MD, MPH, Ramona Yubontoy, MD, Attending Pediatrician, East New York Diagnostic and Treatment Center, Brooklyn   (23 December 2005)

Rapid Correction of Dehydration with Isotonic Saline Solution 23 December 2005
Steve Piecuch, MD, MPH, Clinical Associate Professor of Pediatrics Downstate Medical Center, Ramona Yubontoy, MD, Attending Pediatrician, East New York Diagnostic and Treatment Center, Brooklyn Send letter to journal: Re: Rapid Correction of Dehydration with Isotonic Saline Solution stevepiecuch{at}aol.com Steve Piecuch, MD, MPH, et al.	Neville and associates demonstrate that non-osmotically mediated ADH elevation is common in patients with mild to moderate dehydration due to gastroenteritis and that the administration of hypotonic solutions to such patients may result in the development or persistence of hyponatremia. They conclude that “…hypotonic saline solutions are inappropriate for replacement of acute volume depletion …” Uncomplicated dehydration (i.e., serum sodium 130-150 mEq/L) has traditionally been corrected over a 24 hour period. (1) If one estimates the deficit and replaces it with an isotonic solution, and then adds to that the usual hypotonic maintenance requirements, the end result will be a hypotonic solution. This is the case even though isotonic saline has been used to replace the deficit fraction, because combining an isotonic solution with a hypotonic solution results in a hypotonic solution. In general, if the patient is an infant or young child with 5-10% dehydration, the sodium concentration of the replacement fluid using this approach will be close to that of 0.45% NaCl. The end result will be the administration of a relatively large volume (i.e., deficit and maintenance requirements combined) of a hypotonic saline solution to a patient who may have significantly elevated antidiuretic hormone levels. As Neville and associates have shown, this may result in potentially dangerous hyponatremia. Holliday and associates recently advocated the rapid correction (over 2-4 hours) of uncomplicated dehydration using isotonic saline solution. (2) They recommended administering 20-40 ml/kg in patients with mild- moderate dehydration and 40-80 ml/kg in those with more severe dehydration. This approach rapidly restores extracellular volume without exposing the patient to a relatively large volume of hypotonic solution. The findings of the current study provide additional evidence to support the recommendations of Holliday and associates. The practice of routine 24 hour correction of uncomplicated dehydration should be abandoned. 1. Harriet Lane Handbook, 15th Edition, pp. 229-37. 2. Holliday MA, Friedman AL, Segar WE, Chesney R, Finberg L. Acute hospital-induced hyponatremia in children: a physiologic approach. J Pediatr 2004; 145:584-7. Conflict of Interest: None declared