Prescription practices related to maintenance intravenous fluid in children: A cross sectional, electronic media based survey

Abstract

Background: Maintenance intravenous fluids (IVFs) play a key role in patient management. However, the type of fluids that has to be used should be prudently selected. Past surveys depict the tendency of residents to prescribe hypotonic fluids, following the traditional practice. The increased incidence of hyponatremia has been reported with the use of hypotonic fluids. The study was conducted to investigate the composition and volume of maintenance IVFs prescribed by pediatricians in various clinical settings. Subjects and Methods: A predesigned questionnaire was generated online and distributed via E-mail to pediatricians from teaching institutes, general hospitals, and private clinics. Different clinical scenarios were created, and respondents were asked the composition and volume of IVFs to be prescribed. Results: A total of 438 responses were analyzed. Hypotonic fluids for maintenance therapy were selected by 47% of respondents irrespective of patient's age and clinical condition, whereas 83% opted for hypotonic fluids for infants <2 months, and half of them prescribed very hypotonic fluids in these infants. Isotonic fluids were considered significant in central nervous system infections, head trauma, and as an initial fluid for the management of shock. Variability is evident for the preference of hypotonic versus isotonic fluids and is affected by the clinical position, experience, and workplace of the respondents. Conclusions: The outcome of this survey portrays that the participants are not well aware of the fluid management protocols for children. Formulation of universal guidelines and their implementation is required as the priority to overcome this uncertainty to provide the best care to pediatric patients.