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A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
06:59

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

Published on: November 9, 2016

Usefulness of the serum electrolyte panel in the management of pediatric dehydration treated with intravenously

Joe E Wathen1, Todd MacKenzie, Joan P Bothner

  • 1Department of Pediatrics, Section of Emergency Medicine, University of Colorado Health Sciences Center/Children's Hospital, Denver, Colorado, USA. wathen.joseph@tchden.org

Pediatrics
|November 3, 2004
PubMed

Insights

Routine serum electrolyte panels (SEPs) in dehydrated children receiving intravenous fluids (IVFs) offer limited clinical management changes. While some abnormal SEP values are common, physicians often struggle to predict their significance, impacting treatment decisions.

Area of Science:

  • Pediatric Emergency Medicine
  • Clinical Pathology
  • Laboratory Medicine

Background:

  • Serum electrolyte panels (SEPs) are frequently ordered for pediatric patients with dehydration.
  • The clinical utility of routine SEPs in managing dehydrated children receiving intravenous fluids (IVFs) remains largely unproven.

Purpose of the Study:

  • To evaluate the usefulness of routinely ordered SEPs in the treatment of dehydrated pediatric patients receiving IVFs.
  • To assess the impact of SEP results on clinical management decisions and patient outcomes.

Main Methods:

  • Prospective study of children aged 2 months to 9 years with dehydration receiving IVFs in a pediatric emergency department.
  • Data collected included historical information, physical examination, dehydration severity, and SEP results.
  • Physicians documented predicted SEP importance, and outcomes included changes in management, dispositions, and unscheduled return visits (URVs).

Main Results:

  • 182 patients were enrolled; 48% had at least one abnormal SEP value.
  • Clinically significant findings included low bicarbonate (28%), hypoglycemia (9.9%), hypokalemia (6.0%), and hypernatremia (3.0%).
  • SEP results altered clinical management in 10.4% of cases; physician prediction of clinical significance had 58% sensitivity.

Conclusions:

  • Attending physicians were poor at predicting which children would have clinically significant SEP results.
  • Low bicarbonate levels correlated with observation unit use but not hospitalization or URVs.
  • SEPs can provide useful information for treating some dehydrated children receiving IVFs, particularly when guiding observation unit care.
Abstract

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