To the Editor.—

In their article about acute hyponatremia in hospitalized children, Hoorn et al propose that hypotonic fluids not be administered to children whose plasma sodium concentrations are <138 mmol/L. In their article, Moritz and Ayus go further and recommend 0.9% sodium chloride to provide for maintenance losses, an echo of their previous article. I believe that these authors (and the staff treating the patients in their report) are misinterpreting “maintenance.” Although all children have maintenance needs, those ill enough to be in the hospital generally have water and sodium needs that exceed maintenance from a deficit they have incurred, ongoing losses, or both. Hypotonic fluid, containing 5% dextrose and 0.2% to 0.3% saline, is appropriate for maintenance requirements from basal metabolism but is inappropriate to repair deficits or offset abnormal losses. I would like to call attention to 4 specific issues:

A high rate...

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