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Sodium administration in critically ill paediatric patients in Australia and New Zealand: a multicentre point
Shailesh Bihari1, Marino Festa2, Sandra L Peake3
1Department of Critical Care Medicine, Flinders University, Adelaide, SA, Australia. biharishailesh@gmail.com.
Insights
Children in paediatric intensive care units (PICUs) receive high daily sodium intake. Intravenous fluids, medications like antibiotics, and enteral feeds significantly contribute to this sodium administration.
Area of Science:
- Pediatric critical care medicine
- Clinical nutrition
- Nephrology
Background:
- Dysnatraemia and positive fluid balance are linked to adverse outcomes in pediatric intensive care units (PICUs).
- Understanding sodium intake and fluid balance is crucial for optimizing patient care in PICUs.
Purpose of the Study:
- To quantify daily sodium intake in children admitted to PICUs.
- To determine the total daily fluid balance in this patient population.
Main Methods:
- A single-day point prevalence study was conducted across 10 Australian and New Zealand PICUs.
- Data on demographics, 24-hour fluid balance, and sodium intake from enteral and parenteral sources were collected.
- Patients on free oral diets were excluded from the analysis.
Main Results:
- The study included 48 children, with 21 infants and 27 children over one year of age.
- Median sodium administration was 4.9 mmol/kg, median fluid administration was 80.8 mL/kg, and median fluid balance was 9 mL/kg.
- Intravenous fluids, drugs (notably antibiotics), and enteral feeds were significant sources of administered sodium.
Conclusions:
- Children in PICUs exhibit high daily sodium intake.
- Maintenance and bolus intravenous fluids, drug infusions (including antibiotics), and enteral feeds are major contributors to sodium administration.
- These findings highlight the need for careful monitoring and management of sodium and fluid balance in critically ill children.
Objective:
Dysnatraemia and a positive fluid balance are associated with poor outcomes in paediatric intensive care units (PICUs). Our objective was to determine sodium intake and the total daily fluid balance in children in the PICU.
Method:
A single-day point prevalence study in 10 Australian and New Zealand PICUs. Patients on free oral diets were excluded. Demographics, 24-hour fluid balance and sodium intake (enteral and parenteral sources) were recorded.
Results:
We enrolled 65 patients; 15 were excluded due to having a free oral intake and two patients had incomplete data, leaving 48 children in the study cohort. The 21 infants had a median age of 4 months (interquartile range [IQR], 1-7 months) and a median bodyweight of 5 kg (IQR, 3.5- 6.1 kg). The 27 children > 1 year had a median age of 3 years (IQR, 1.5-13 years) and a median bodyweight of 17 kg (IQR, 9.5-47.5 kg). Overall, the median sodium administration on the study day was 4.9mmol/kg (IQR, 3.2- 8mmol/kg), median fluid administration was 80.8mL/kg (IQR, 49.8-111.4mL/kg) and median fluid balance was 9mL/kg (IQR, -1.4 to 41 mL/kg). For infants, the median sodium administration was 6mmol/kg (IQR, 3.9-8.1mmol/ kg), and median fluid balance was 20.8mL/kg (IQR, 3.5- 47.2mL/kg). For children > 1 year, the median sodium administration was 3.5mmol/kg (IQR, 3.1-7.8mmol/kg), and median fluid balance was 5.3mL/kg (IQR, -2.7 to 17.7mL/kg). Overall, fluid infusions, boluses and catheter flushes together contributed 46.2% of total sodium administered. Drugs contributed substantially to administered sodium (33.3%), with antibiotics accounting for the majority. Enteral feeds contributed 16.2% to overall administered sodium, and were the major source in patients in the PICU for > 10 days.
Conclusion:
Daily sodium intake in children in the PICU is high. The contributions of maintenance and bolus intravenous fluids (most commonly as 0.9% sodium chloride), drug infusions and boluses, including antibiotics, and enteral feeds, are significant.
