In children requiring intravenous fluid for hydration maintenance, which out of hypotonic saline and isotonic saline is less likely to result in the development of hyponatraemia?

The administration of intravenous fluids remains a common intervention for hospitalised children. Commonly used hypotonic fluids administered at maintenance rates provide 2-4 mmol/kg/day of sodium. Being hypotonic, the development of hyponatraemia remains a risk. The consequences of hyponatraemia are not insignificant, with possibilities of irreversible neurological morbidity and mortality. There is currently no clear consensus on the optimal composition of fluids to be used for intravenous rehydration. A review of the available literature suggests that children who receive isotonic fluid have a lower risk of developing hyponatraemia, regardless of the rate of administration. This result is most applicable in the first 24 h of administration in a wide age group of paediatric patients with varying severities of illness.