ArticleThe Journal of pediatrics2013
Association between maintenance fluid tonicity and hospital-acquired hyponatremia.
Article in The Journal of pediatrics, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 1 of them a synthesis that pooled it.
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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.
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.
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Who cites it
31 citing papers in PubMed, 1 synthesis or guideline pooled it, 77 citations in OpenAlex.
- ESPNIC clinical practice guidelines: intravenous maintenance fluid therapy in acute and critically ill children- a systematic review and meta-analysis.Intensive care medicine · 2022Pooled it
- Hyponatremia after pediatric surgery: Randomized trial of fluid composition on antidiuretic hormone response.Pediatric research · 2026Trial
- Effectiveness of a novel 1% glucose isotonic electrolyte solution for intraoperative fluid therapy in children: a randomized controlled trial.The Journal of international medical research · 2021Trial
- Dysnatremias in pediatric victims of the 2023 Türkiye-Syria earthquake.Pediatric nephrology (Berlin, Germany) · 2025Article
- Article
- A balancing act: drifting away from the reflexive use of "ab"normal saline.Pediatric nephrology (Berlin, Germany) · 2024Review
- Management of Pediatric Parenteral Fluids.The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG · 2024Article
- Thalamic Neuron Resilience during Osmotic Demyelination Syndrome (ODS) Is Revealed by Primary Cilium Outgrowth and ADP-ribosylation factor-like protein 13B Labeling in Axon Initial Segment.International journal of molecular sciences · 2023Article
- Review
- Hyponatremia among Postoperative Children Administered with Hypotonic Fluids in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.JNMA; journal of the Nepal Medical Association · 2021Article
- Prevalence, prognostic value, pathophysiology, and management of hyponatraemia in children and adolescents with COVID-19.Acta bio-medica : Atenei Parmensis · 2021Review
- Fluid Rate Is Important As Much As Fluid Tonicity: An Experimental Study.The Eurasian journal of medicine · 2021Article
- Hyponatremia During Induction Therapy in Distinct Pediatric Oncological Cohorts: A Retrospective Study.Frontiers in oncology · 2021Article
- Association Between Hyponatremia and Maintenance Intravenous Solutions in Critically Ill Children: A Retrospective Observational Study.Frontiers in pediatrics · 2021Article
- Choice of maintenance intravenous fluids among paediatric residents in Canada.Paediatrics & child health · 2020Article
- Are Further Interventions Needed to Prevent and Manage Hospital-Acquired Hyponatraemia? A Nationwide Cross-Sectional Survey of IV Fluid Prescribing Practices.Journal of clinical medicine · 2020Article
- Prevalence and Clinical Significance of Hyponatremia in Pediatric Intensive Care.Journal of pediatric intensive care · 2019Article
- Hyponatremia in children under 100 days old: incidence and etiologies.European journal of pediatrics · 2019Observational
- Hospital-Acquired Hyponatremia in Children Following Hypotonic versus Isotonic Intravenous Fluids Infusion.Children (Basel, Switzerland) · 2018Article
- Hospital-acquired Hyponatremia in Pediatric Intensive Care Unit.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2017Article
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Authors and funding
7 authors at 4 institutions in 1 country.
Funding
Abstract
objectiveTo evaluate whether the administration of hypotonic fluids compared with isotonic fluids is associated with a greater risk for hyponatremia in hospitalized children. STUDY
designInformatics-enabled cohort study of all hospitalizations at Lucile Packard Children's Hospital between April 2009 and March 2011. Extraction and analysis of electronic medical record data identified normonatremic hospitalized children who received either hypotonic or isotonic intravenous maintenance fluids upon admission. The primary exposure was the administration of hypotonic maintenance fluids, and the primary outcome was the development of hyponatremia (serum sodium <135 mEq/L).
resultsA total of 1048 normonatremic children received either hypotonic (n = 674) or isotonic (n = 374) maintenance fluids upon admission. Hyponatremia developed in 260 (38.6%) children who received hypotonic fluids and 104 (27.8%) of those who received isotonic fluids (unadjusted OR 1.63; 95% CI 1.24-2.15, P < .001). After we controlled for intergroup differences and potential confounders, patients receiving hypotonic fluids remained more likely to develop hyponatremia (aOR 1.37, 95% CI 1.03-1.84). Multivariable analysis identified additional factors associated with the development of hyponatremia, including surgical admission (aOR 1.44, 95% CI 1.09-1.91), cardiac admitting diagnosis (aOR 2.08, 95% CI 1.34-3.20), and hematology/oncology admitting diagnosis (aOR 2.37, 95% CI 1.74-3.25).
conclusionsHyponatremia was common regardless of maintenance fluid tonicity; however, the administration of hypotonic maintenance fluids compared with isotonic fluids was associated with a greater risk of developing hospital-acquired hyponatremia. Additional clinical characteristics modified the hyponatremic effect of hypotonic fluid, and it is possible that optimal maintenance fluid therapy now requires a more individualized approach.
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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.