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PAC conference: McNab on a fluid solution


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The DFTB team have teamed up with APLS to share the videos from their Paediatric Acute Care Conferences. These videos have never been open access before, so if you weren’t able to attend the conferences, then now’s your chance to catch up.

The PAC Conference is run each year by APLS and consists of presentations on a range of topics relevant to paediatric acute and critical care.

Sarah is a sleep-deprived mother of two young boys. In her spare time she is a General Paediatrician working at the Royal Children’s Hospital, Melbourne and is currently completing a PhD. She was the lead investigator in the PIMS (Paediatric Intravenous Maintenance Solution) study: a large, randomised control trial comparing isotonic and hypotonic fluids for maintenance hydration in children. She has particular interests in quality and safety in healthcare as well as education.

This lecture takes us on an eloquent journey through the reasoning and evidence behind fluid choices that we have made in the past and those that we continue to make today. For those who are unsure as to why a particular fluid is commonly used in their local practice, this lecture is invaluable. Dr McNab also describe her landmark PIMS study comparing half normal saline with plasmalyte for maintenance fluids in children, and finishes with a discussion of the CRIB study looking at fluid supplementation in bronchiolitis.

Key points:

  • an isotonic fluid should be used as IV fluid for maintenance hydration in children
  • most sick children produce excess ADH
  • hypotonic fluids lead to hyponatraemia
  • PIMS showed plasmolyte caused less hyponatraemia than 0.45% saline with 5% dextrose
  • CRIB did not show a significant difference in outcomes between IV and NG fluid use in children with bronchiolitis

You can read PIMS in The Lancet (subscription required). Lancet 385(9974);1190-1197. 28 March 2005.


About the authors

  • Ben Lawton is a paediatric emergency physician interested in education, retrieval medicine and simulation. Lives in Brisbane where he enjoys falling off his mountain bike and being outsmarted by his pre-teen children. @paedsem | + Ben Lawton | Ben's DFTB posts


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