ALI in children is uncommon but has a high mortality rate. Risk factors for mortality are easily identified. Ventilatory variables and indexes of lung severity were significantly associated with mortality.

The 2009 H1N1 virus had a substantial effect on ICUs during the winter in Australia and New Zealand. Our data can assist planning for the treatment of patients during the winter in the Northern Hemisphere.

Aim: Traditional paediatric intravenous maintenance fluids are prescribed using hypotonic fluids and the weight-based 4:2:1 formula for administration rate. However, this may cause hyponatraemia in sick and post-operative children. We studied the effect of two types of intravenous maintenance fluid and two administration rates on plasma sodium concentration in intensive care patients. Methods: A Factorial-design, double-blind, randomised controlled trial was used. We randomised 50 children with normal electrolytes without hypoglycaemia who needed intravenous maintenance fluids for >12 h to 0.9% saline (normal saline) or 4% dextrose and 0.18% saline (dextrose saline), at either the traditional maintenance fluid rate or 2/3 of that rate. The main outcome measure was change in plasma sodium from admission to 12-24 h later. Results: Fifty patients (37 surgical) were enrolled. Plasma sodium fell in all groups: mean fall 2.3 (standard deviation 4.0) mmol/L. Fluid type (P = 0.0063) but not rate (P = 0.12) was significantly associated with fall in plasma sodium. Dextrose saline produced a greater fall in plasma sodium than normal saline: difference 3.0, 95% confidence interval 0.8-5.1 mmol/L. Full maintenance rate produced a greater fall in plasma sodium than restricted rate, but the difference was small and non-significant: 1.6 (-0.7, 3.9) mmol/L. Fluid type, but not rate, remained significant after adjustment for surgical status. One patient, receiving normal saline at restricted rate, developed asymptomatic hypoglycaemia. Conclusion: Sick and post-operative children given dextrose saline at traditional maintenance rates are at risk of hyponatraemia.Key words: child; fluid therapy; infusion; intravenous.Intravenous (IV) fluids have been used in paediatrics for over 50 years. The most commonly used maintenance fluid, used to replace normal expected fluid losses in situations such as fasting, is hypotonic saline with dextrose. Volumes are typically calculated using a weight-based infusion rate: for the first 10 kg, 4 mL/kg/h, for the next 10 kg, 2 mL/kg/h and 1 mL/kg/h for each kilogram thereafter.1-6 However, it may be inappropriate for those children who have non-osmotic production of antidiuretic hormone (ADH). The syndrome of inappropriate ADH 7 occurs in meningitis, 8,9 encephalitis, 10 pneumonia, 11 bronchiolitis 12 and after surgery. [13][14][15][16] Any consequent hyponatraemia may be exacerbated by hypotonic IV fluids. 14,17 Natriuresis (urinary salt loss) may cause hyponatraemia. Sodium loss and hypovolaemia occur in cerebral salt wasting (CSW), 18,19 probably caused by a hormone such as atrial natriuretic hormone.19 Hyponatraemia in neurosurgical patients may be from CSW, not the syndrome of inappropriate ADH.20 CSW occurs in children with neurological illness, neurosurgery and craniofacial surgery. 21-23Symptomatic hyponatraemia is uncommon if the plasma sodium ([Na]) is >120-125 mmol/L, 24,25 but depends on the rate of fall, 26 and can occur at higher values. 17 It can cause death or serious neurological mo...

Hyperglycemia is common in PICUs, occurs early, and is independently associated with organ failure and death. However, early hyperglycemia is not associated with later or worsening organ failure. Australasian PICUs seldom use insulin.