![]() The responses are shown (A) by question and fluid option and (B) by fluid type: hypotonic or isotonic. The respondents predominantly selected hypotonic fluids in the first three cases. In the present study, we performed a survey-based analysis of maintenance fluid prescription practices, targeting resident trainees in pediatrics to evaluate their knowledge and understanding of current fluid therapy issues and awareness regarding hyponatremia. Considering that these textbooks are the sources of the primary guidelines for pediatric care, residents might not be as aware as they should be of the most current fluid prescription issues. The 10th edition of the Korean Textbook of Pediatrics 7) specifies that hypotonic fluids must be avoided in intensive care contexts, even where children weigh less than 10 kg. 243), unless the patient has volume depletion, as based on Holliday's method 1). The nineteenth and most recent edition of Nelson Textbook of Pediatrics 6), the most commonly referred textbook, still states that "the usual choices for maintenance fluid therapy in children are 0.5 normal saline (NS) and 0.2 NS" (p. Yet, universal agreement on fluid sodium concentrations in cases of pediatric maintenance intravenous administration remains elusive. Moritz and Ayus 2) introduced the idea of using 0.9% saline as the maintenance fluid, and several succeeding studies, based on the results of randomized trials, have supported this level as the safer choice 3- 5). ![]() Concerns arose, however, that a hypotonic solution carries risks of water overload and subsequent hyponatremia, which can lead to fatal outcomes 2). The traditional maintenance fluid in pediatrics is 0.2% saline in 5% dextrose water (DW), as based on the fact that sodium concentration of 30 mEq/L approximates the sodium composition of human breast milk and cow's milk 1). ![]() Fluid management is an essential component of pediatric practice, especially in intensive care and postoperative contexts.
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