Maintenance Fluid in Hospitalized Children 
Intravenous fluids (IVFs) should be thought of as a medication by those who prescribe them.
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Based on a growing body of evidence, the AAP recommends isotonic fluid as the most appropriate for the vast majority of hospitalized children between the ages of 28 days and 18 years.
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Various disease states can lead to an increased secretion of antidiuretic hormone (ADH), which promotes the retention of free water, leading to hyponatremia.
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Exceptions exist in certain patient populations, such as children with
neurosurgical disorders.
congenital or acquired cardiac disease.
hepatic disease, cancer.
acute kidney injury, chronic kidney disease.
nephrotic syndrome.
diabetes insipidus.
voluminous watery diarrhea or severe burns.
- Unless hyperkalemia is present or the child is in renal failure, maintenance potassium requirements (20 mEq/L of fluid) should be given.
Do not add potassium (K+) to fluids until urine output has been established.
Volume Replacement Strategy
1.Volume resuscitation and deficit replacement should generally be completed over 24 hours.
2 .Children with isonatremic hypovolemia can be repleted with isotonic fluid per AAP recommendations.
3.Oral intake is the preferred method for repletion and maintenance, if possible.
If ongoing losses can be measured directlythey should be replaced 1:1 concurrently with maintenance fluid administration.
If the losses cannot be measured estimate of
10 mL/kg body weight for each watery stool and
2 mL /kg body weight for each episode of emesis
should be administered.