Crystalloids Vs Colloids For Fluid Replacement In Pediatrics

Abstract

Age-related changes in body composition explain the necessity to provide larger volumes of fluid during infancy as maintenance requirements are higher than later in life, but also to administer larger quantity of fluids to compensate for third space losses and to restore effective vascular volume. Recent studies have reevaluated the risk of hyperglycemia especially in children at risk of hypoxic-ischemic episodes, and that of hyponatremia, the most frequent postoperative electrolyte disorder, both of them being likely to promote or to aggravate permanent or transient brain damage. Recommendations for volume expansion should be made based on side effects, mechanisms of action, and cost. Thus ,isotonic saline was recommended as safe, effective, and less expensive than albumin. In most recent studies of colloids versus crystalloids for fluid resuscitation in children ,the authors concluded that there is no evidence to support the use of colloids over crystalloids , because they are expensive and not associated with improved survival. Whether the choice of plasma substitute can be life saving is still a matter of debate. For rational decision making in fluid management, an improved understanding of the impact of the different products on hemostasis is necessary. In addition volume expanding efficacy, safety index, and individual adverse effects need to be considered .Albumin can no longer be considered as the first choice colloid for volume replacement in children, dextrans appear to have the poorest risk/benefit ratio owing to their relevant anaphylactoid potential , risk of renal failure , and , perhaps their major impact on hemostasis.