M. Grošelj Grenc
Klinični oddelek za otroško kirurgijo in intenzivno terapijo, Kirurška klinika, Univerzitetni klinični center Ljubljana, Ljubljana, Slovenija
Intravenous fluid replacement is typically required in surgical, critically ill or acutely ill children. Several studies, meta-analyses and review articles have been published, which investigated the effectiveness of different fluid types, different dosing and timing regimens and morbidity and mortality associated with their use. All indicated that these are crucial parameters influencing the outcomes in children. This article addresses the three commonest dilemmas in fluid therapy: colloids vs crystalloids, normal saline vs balanced crystalloids, and liberal vs restrictive fluid regimen. Similar to other European countries, we generally begin fluid replacement using crystalloids in shocked children. If there is no response after two or three (in the case of septic shock) boluses of crystalloids, we next use the most appropriate colloids. In children, balanced crystalloids have supplanted the traditional hypotonic solutions with glucose and electrolytes, which often caused hyponatraemia and hyperglycaemia. Restrictive fluid regimens are often preferred in view of the data showing poorer outcomes in children with fluid overload.
Key words: intravenous fluids, children, fluid replacement, isotonic, hypotonic, shock.