Benefits and risks Sublingual administration of sugar in treatment of hypoglycaemia

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12. Evidence for recommendations on the choice of intravenous fluids

12.1 Choice of intravenous fluids for resuscitation and maintenance in

children a Resuscitation: Children severely dehydrated or with signs of shock should be resuscitated using isotonic intravenous IV solutions such as sodium chloride 0.9 or ringers lactate. Strong recommendation, low quality evidence b Intravenous maintenance luid: For children who require intravenous IV luids for maintenance, options include ringers lactate solution with 5 dextrose, sodium chloride 0.45 with glucose 5, sodium chloride 0.45 with glucose 2.5, or 0.9 sodium chloride with glucose 5. Strong recommendation, low quality evidence c Low sodium-containing IV solutions such as sodium chloride 0.18 with glucose 4, or 5 glucose in water, should not be used as there is an increased risk of hyponatraemia. Strong recommendation, low quality evidence here is evidence that there is a greater level of risk of hyponatraemia associated with the use of very low sodium-containing solutions in paediatric patients in comparison to luids where the sodium content is 75–150mmolL. he panel also emphasized that IV maintenance luids should contain glucose to avoid hypoglycaemia and starvation ketosis. Enteral feeding should be used in sick children, as it provides nutrition and avoids complications associated with IV luids. If oral nutrition is not tolerated, nasogastric tube feeding should be considered.

12.1.1 Evidence and summary of findings

here is evidence of a greater level of risk of hyponatraemia associated with the use of hypotonic solutions: the odds of developing hyponatraemia following hypotonic solutions are 17.2 times greater than with isotonic luids. Within the range of hypo- tonic solutions available, the use of sodium chloride 0.18 with glucose 4 presents an even greater risk. he panel identiied a systematic review published in 2006 that sought to compare outcomes for children receiving hypotonic versus isotonic luid therapy [Choong, 2006]. he review included six studies: two controlled trials of children 1-12 years,