Evidence map›Paper›PMID 16754657›Full record

SynthesisArchives of disease in childhood2006

Hypotonic versus isotonic saline in hospitalised children: a systematic review.

K Choong, M E Kho, K Menon, D Bohn

3 registry-linked trialsOpen access · bronzeAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Archives of disease in childhood, 2006. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 41 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
41citing papers in PubMed, 3 pooled it
9.6field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01251770 phase3completednot on this mapstarted 2010, after this paper: background citation

Variation in Natremia Using Two Different Maintenance Intravenous Fluids in Postsurgical Hospitalized Children

TypeinterventionalSponsorHospital General de Niños Pedro de ElizaldeRan2010 to 2011Enrolled78ConditionsHyponatremiaArms0.45% NaCl/dextrose 5%, 0.3% NaCl/dextrose 5%
NCT01301274 nacompletednot on this mapstarted 2011, after this paper: background citation

Randomized, Controlled, Double Blinded, Clinical Trial: 0.9% NaCl/Dextrose 5% vs 0.45% NaCl/Dextrose 5% as Maintenance Intravenous Fluids in Critically Ill Children

TypeinterventionalSponsorHospital General de Niños Pedro de ElizaldeRan2011 to 2011Enrolled66ConditionsHyponatremiaArmshypotonic, isotonic
NCT01909336 phase3completednot on this mapstarted 2013, after this paper: background citation

Use of Isotonic Solutions Versus Hypotonic Solutions for Preventing Hospital Acquired Hyponatremia.

TypeinterventionalSponsorInstituto Tecnologico y de Estudios Superiores de MontereyRan2013 to 2014Enrolled161ConditionsHyponatremiaArms0.3% Saline in 3.3% dextrose, 0.45% Saline in 5% dextrose, 0.9% Saline in 5% dextrose
3 · Its place in the literature

Who cites it

41 citing papers in PubMed, 3 syntheses or guidelines pooled it, 191 citations in OpenAlex.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

4 authors at 1 institution in 1 country.

K ChoongDepartment of Paediatrics, McMaster University, Hamilton, Ontario, Canada. choongk@mcmaster.ca
M E Kho
K Menon
D Bohn
McMaster University · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe traditional recommendations which suggest that hypotonic intravenous (i.v.) maintenance fluids are the solutions of choice in paediatric patients have not been rigorously tested in clinical trials, and may not be appropriate for all children.

aimsTo systematically review the evidence from studies evaluating the safety of administering hypotonic versus isotonic i.v. maintenance fluids in hospitalised children.

methodsDATA SOURCES: Medline (1966-2006), Embase (1980-2006), the Cochrane Library, abstract proceedings, personal files, and reference lists. Studies that compared hypotonic to isotonic maintenance solutions in children were selected. Case reports and studies in neonates or patients with a pre-existing history of hyponatraemia were excluded.

resultsSix studies met the selection criteria. A meta-analysis combining these studies showed that hypotonic solutions significantly increased the risk of developing acute hyponatraemia (OR 17.22; 95% CI 8.67 to 34.2), and resulted in greater patient morbidity.

conclusionsThe current practice of prescribing i.v. maintenance fluids in children is based on limited clinical experimental evidence from poorly and differently designed studies, where bias could possibly raise doubt about the results. They do not provide evidence for optimal fluid and electrolyte homoeostasis in hospitalised children. This systematic review indicates potential harm with hypotonic solutions in children, which can be anticipated and avoided with isotonic solutions. No single fluid rate or composition is ideal for all children. However, isotonic or near-isotonic solutions may be more physiological, and therefore a safer choice in the acute phase of illness and perioperative period.

Indexed as

AdolescentChildChild, PreschoolContraindicationsEvidence-Based MedicineFluid TherapyHospitalizationHumansHyponatremiaInfantIsotonic SolutionsSaline Solution, HypertonicSodium ChlorideIsotonic SolutionsSaline Solution, HypertonicSodium Chloride

Identifiers

PMID16754657
PMCPMC2066024
OpenAlexW2150390748

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.