Variations in intravenous fluid management for paediatric hypernatraemia in South Africa: A survey of junior and senior South African paediatric doctors

Main Article Content

M Milovanovic
S Omar
S G Lala
Z Dangor


Background. Paediatric hypernatraemia is a severe and life-threatening electrolyte abnormality that is associated with considerable morbidity and mortality. Although intravenous (IV) fluid therapy is a crucial component of management, there are no management guidelines, and varying approaches to IV fluid therapy are commonplace in clinical practice.

Objectives. To determine the variance in IV fluid therapy in the management of paediatric hypernatraemia among paediatric registrars and consultants in South Africa.

Methods. A self-administered online survey was conducted from November 2020 to February 2021. The survey assessed paediatricians’ management of three typical clinical scenarios of community-acquired hypernatraemia seen in South Africa. Descriptive results were presented as proportions, frequencies and medians with interquartile ranges. Comparisons were done using contingency tables.

Results. Responses from 119 participants were analysed. Most respondents worked in the state sector (69.8%), and were based mainly in Gauteng (46.2%) or Western Cape (25.2%) province. Most (60.2%) respondents considered a serum sodium level ≥146 mmol/L indicative of hypernatraemia, and 43.6% (n=51/117) reported seeing >10 cases of paediatric hypernatraemia in 2019. For all three cases, at least eight different types of infusate (of varying sodium concentrations) were chosen as maintenance fluids. Fluid deficits were calculated using either the free water method or based on the perceived degree/percentage of clinical dehydration.

Conclusion. There is considerable variability in the management of hypernatraemia among paediatricians in South Africa. There is an urgent need to develop a standardised guideline for the treatment of paediatric hypernatraemia.

Article Details

How to Cite
Variations in intravenous fluid management for paediatric hypernatraemia in South Africa: A survey of junior and senior South African paediatric doctors. (2023). South African Journal of Child Health, 17(4), 216-221.

How to Cite

Variations in intravenous fluid management for paediatric hypernatraemia in South Africa: A survey of junior and senior South African paediatric doctors. (2023). South African Journal of Child Health, 17(4), 216-221.


Moritz ML, Ayus JC. The changing pattern of hypernatremia in hospitalised children. Pediatrics 1999;104(3 Pt 1):435-439. peds.104.3.435

Koklu E, Gunes T, Ozturk M, et al. A review of 116 cases of breastfeeding associated hypernatremia in a rural area of central Turkey. J Trop Pediatr 2007;53:347-350.

Ben-Shalom E, Toker O, Schwartz S. Hypernatremic dehydration in young children: Is there a solution? Isr Med Assoc J 2016;18:95-99.

Chisti MJ, Ahmed T, Ahmed AM, et al. Hypernatremia in children with diarrhea: Presenting features, management, outcome, and risk factors for death. Clin Pediatr (Phila) 2016;55(7):654-663.

Pettifor JM, Lala SG. Hypernatraemic dehydration – do we have consensus on its management. [Editorial] S Afr J Child Health 2018;12(1):2.

Anigilaje EA. Management of diarrhoeal dehydration in childhood: A review for clinicians in developing countries. Front Pediatr 2018;6:28. https://doi. org/10.3389/fped.2018.00028

Shahrin L, Chisti MJ, Huq S, et al. Clinical manifestations of hyponatremia and hypernatremia in under-five diarrheal children in a diarrhea hospital. J Trop Pediatr 2016;62(3):206-212.

Hariram T, Naidoo K, Ramji S. Hypernatraemic dehydration in infants with acute gastroenteritis at King Edward VIII Hospital. S Afr J Child Health 2018;12(1):10-14. SAJCH.2018.v12i1.1424

Cooke ML, Nel ED, Cotton MF. Pre-hospital management and risk factors in children with acute diarrhoea admitted to a short-stay ward in an urban South African hospital with a high HIV burden. S Afr J Child Health 2013;7(3):84- 87.

Hoosain SBG. Hypernatraemic dehydration in acute gastroenteritis – a descriptive audit of prehospital management and predisposing factors. jspu/bitstream/10539/23167/1/Research%20 report%20 final.pdf (accessed 9 April 2018).

Naka N, Solomon F, Madhi SA, et al. Borderline hypernatraemia and mortality rates in South African infants: A single-centre observational study. S Afr J Child Health 2023. Forthcoming issue 4 of 2023. index.php/sajch/article/view/1449

Maitland K, Kiguli S, Opoka RO, et al. Mortality after fluid bolus in African children with severe infection. N Engl J Med 2011;364(26):2483- 2495.

Regina GC. Hypo versus isotonic solutions in

intravenous fluid maintenance of acutelly ill pediatric patients. J Anesth Intensive Care Med 2017;2(3):555589. JAICM.2017.02.555589

Fang C, Mao J, Dai Y, et al. Fluid management of hypernatraemic dehydration to prevent cerebral oedema: A retrospective case control study of 97 children in China. J Paediatr Child Health 2010;46(6):301-303. j.1440-1754.2010.01712.x

Health Professions Council of South Africa. Annual Report 2020/2021. https://www.hpcsa. Report/HPCSA%20FY2020-21%20Annual%20 Report%20Approved%20Final.pdf

Holliday MA, Segar WE. The maintenance need for water in parenteral fluid therapy. Pediatrics 1957;19(5):823-832.

Murad MH. Clinical practice guidelines: A primer on development and dissemination. Mayo Clin Proc 2017;92(3):423-433. https://doi. org/10.1016/j.mayocp.2017.01.001

Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J. Clinical guidelines: Potential benefits, limitations, and harms of clinical guidelines. BMJ 1999;318(7182):527-530.

Kahneman D, Sibony O, Sunstein CR. Noise: A flaw in human judgement. 1st ed. New York: Little Brown Spark; 2021.

Graham ID, Harrison MB. Evaluation and adaptation of clinical practice guidelines. Evid Based Nurs 2005;8(3):68-72. https://doi. org/10.1136/ebn.8.3.68

Most read articles by the same author(s)