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Relationship between fluid management, changes in serum sodium and outcome in hypernatraemia associated with
Gillian Robertson1, Michelle Carrihill, Mark Hatherill
1Paediatric Intensive Care Unit, Red Cross War Memorial Children's Hospital, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa. gillianr@ich.uct.ac.za
Insights
Fluid management in critically ill children with hypernatraemic gastroenteritis did not show a significant link between the intravenous solution
Area of Science:
- Pediatric Critical Care Medicine
- Pediatric Nephrology
- Pediatric Gastroenterology
Background:
- Hypernatraemic gastroenteritis is a severe condition in critically ill children.
- Fluid management and serum sodium levels are crucial in treating these patients.
- Understanding the relationship between rehydration strategies and patient outcomes is vital.
Purpose of the Study:
- To investigate the association between fluid management strategies, serum sodium levels, and clinical outcomes in critically ill children diagnosed with hypernatraemic gastroenteritis.
- To determine if specific intravenous fluid compositions or correction rates impact adverse events such as seizures, neurological deficits, or mortality.
Main Methods:
- A retrospective analysis was conducted on 57 children with hypernatraemic gastroenteritis admitted to a pediatric intensive care unit.
- Data collected included fluid management details, serum electrolytes, and adverse outcomes (seizures, neurological deficit, mortality).
- Statistical analyses, including univariate and multivariate methods, were employed to assess relationships.
Main Results:
- The median admission serum sodium level was 165 mmol/L.
- Intravenous rehydration fluid averaged 6 mL/kg/h with a sodium concentration of 61 mmol/L, leading to a median sodium fall of 0.6 mmol/L/h.
- Adverse outcomes occurred in 25% (seizures), 7% (mortality), and 9% (neurological deficit); however, neither the sodium content of the intravenous solution nor the rate of serum sodium correction was independently associated with these outcomes in multivariate analysis.
Conclusions:
- Rehydration of hypernatraemic gastroenteritis with intravenous solutions containing 61 mmol/L sodium is associated with an approximate serum sodium correction rate of 0.6 mmol/L/h.
- The study found no independent association between the sodium content of intravenous solutions or the rate of serum sodium correction and adverse outcomes in critically ill children with hypernatraemic gastroenteritis.
Objective:
To describe the relationship between fluid management, serum sodium and outcome in critically ill children with hypernatraemic gastroenteritis.
Methods:
A retrospective study of 57 children with hypernatraemic gastroenteritis admitted to a paediatric intensive care unit in Cape Town, South Africa. Data were collected on fluid management, serum electrolytes and adverse outcome (seizures, new neurological deficit and mortality) and analysed using univariate and multivariate statistics.
Results:
Median admission sodium was 165 mmol/L (145-199). Median volume of intravenous rehydration fluid was 6 mL/kg/h (144 mL/kg/day), with sodium concentration of 61 mmol/L (0-154 mmol/L), resulting in a median fall in sodium of 0.6 mmol/L/h (14.4 mmol/L/day). Fourteen children (25%) had seizures during rehydration, four children (7%) died and five children (9%) developed neurological deficit. Median admission sodium in children with adverse outcome was 172 mmol/L, with rate of fall of 0.63 mmol/L/h, compared with median admission sodium of 163 mmol/L and rate of fall of 0.48 mmol/L/h, in children with good outcome (P=0.068 and P=0.08, respectively). Median sodium content of intravenous solution was 61 mmol/L in both groups (P=0.68). Multivariate analysis demonstrated that neither sodium content of intravenous solution (P=0.59), nor rate of fall of sodium (P=0.31), was independently associated with adverse outcome.
Conclusions:
Rehydration in hypernatraemic gastroenteritis using intravenous solutions containing 61 mmol/L sodium would be expected to correct serum sodium at a rate of approximately 0.6 mmol/L/h. Neither sodium content of the intravenous solution, nor rate of correction of sodium, was independently associated with adverse outcome.
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