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[Short-term infusion therapy in childhood. A comparison of individually mixed with commercial infusion solutions]
Insights
Parenteral sodium dosage in children varies widely. High intravenous sodium intake in healthy children reduced sodium excretion and renal function, suggesting caution with commercial solutions.
Area of Science:
- Pediatric Nephrology
- Clinical Nutrition
- Intravenous Fluid Therapy
Background:
- Textbook recommendations for parenteral sodium dosage in children vary significantly (by a factor of 4).
- Existing data lacks consensus on optimal intravenous sodium administration in pediatric populations.
- Healthy children without renal disease were studied to assess sodium balance and renal function under different infusion rates.
Purpose of the Study:
- To investigate the effects of low versus high intravenous sodium dosages on sodium balance and renal function in healthy children.
- To compare the impact of individually composed solutions versus commercial ready-for-use mixtures.
- To determine a potentially balanced sodium infusion rate and assess renal clearance changes.
Main Methods:
- Two groups of healthy children received intravenous fluids for 12 hours: Group 1 (n=13) received individually composed low-sodium solutions (2.2 mmol Na/kg/d), and Group 2 (n=17) received commercial high-sodium mixtures (5.1 mmol Na/kg/d).
- Sodium excretion in urine was monitored, and renal clearance of creatinine was measured.
- Regression analysis was used to estimate a balanced sodium infusion rate.
Main Results:
- Sodium excretion into the urine was unchanged in the low-sodium group but significantly lowered in the high-sodium group compared to baseline.
- Regression analysis suggested an infusion of 2.7 mmol Na/kg/d for sodium balance, but baseline overload was indicated by control period excretion.
- Renal clearance of creatinine remained unchanged in Group 1 but was significantly reduced in Group 2 (131 vs. 94 ml/min/1.73 m2; p < 0.01).
Conclusions:
- High intravenous sodium administration in healthy children can lead to decreased sodium excretion and impaired renal function.
- Commercial ready-for-use intravenous solutions may pose a risk due to potentially excessive sodium content.
- Further research is recommended to elucidate the mechanisms and clinical significance of these findings before routine use of commercial solutions.
Abstract:
Data of parenteral sodium dosage in healthy children recommended by several textbooks vary by the factor 4. Therefore, we studied the effect of low and high i.v. dosage administered in 5-5.5% glucose for 12 hrs to probands without renal disease. Group 1: n = 13; Na 2.2 +/- 0.4, K 1.7 +/- 0.2, Cl 4.2 +/- 0.6 mmol/kg/d, individually composed solutions. Group 2: n = 17; Na 5.1 +/- 1.3, K 1.6 +/- 0.5, Cl 5.8 +/- 1.5, acetate 2.4 +/- 0.6 mmol/kg/d; Ca, Mg, malate, glycerol phosphate below 0.3 mmol/kg/d; commercial ready-for-use mixtures. Compared to the control period, the excretion of Na into the urine was unchanged in group 1 during the infusion but significantly lowered in group 2. Regression analysis reveals that infusion of 2.7 mmol Na/kg/d would have given a balanced sodium balance. The real parenteral requirement, however, may be below this value, as the excretion of Na during the control period indicates that the probands in both groups were overloaded with Na before the beginning of the study. During infusion, the renal clearance of creatinine was unchanged in group 1 but significantly lowered in group 2 (131 +/- 58 vs. 94 +/- 38 ml/min/1.73 m2; p less than 0.01). We would like to recommend to elucidate the mechanism and the clinical significance of this effect before using the commercial solution in clinical routine.