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Fluid therapy and iatrogenic hyponatraemia risk in children hospitalised with acute gastroenteritis: prospective
Insights
Hypotonic fluids are safe for treating dehydration in children with acute gastroenteritis. This study found no increased risk of hyponatremia (low sodium) when using these fluids in hospitalized pediatric patients.
Area of Science:
- Pediatric Nephrology
- Pediatric Critical Care
- Pediatric Emergency Medicine
Background:
- Iatrogenic hyponatremia is a concern in pediatric fluid management.
- Acute gastroenteritis (AGE) commonly leads to dehydration in children.
- Intravenous hypotonic fluids are frequently used for rehydration.
Purpose of the Study:
- To investigate if hypotonic fluid administration increases the risk of iatrogenic hyponatremia in children hospitalized with acute gastroenteritis (AGE).
Main Methods:
- A prospective study involving 205 pediatric patients (1-28 months) with mild to moderate dehydration due to AGE.
- Patients received intravenous hypotonic fluids (0.3% glucosaline or 0.2% gluco-hyposaline).
- Serum sodium levels and fractional excretion of sodium (EFNa) were measured before and after fluid administration.
Main Results:
- Baseline hyponatremia was present in 18.04%, isonatremia in 64.87%, and hypernatremia in 17.07% of patients.
- Administration of hypotonic fluids led to a significant change in natremia across all groups.
- No cases of post-infusion hyponatremia were observed, and no correlation was found between free water administration and natremia changes.
Conclusions:
- Hypotonic intravenous fluid therapy does not elevate the risk of hospital-acquired hyponatremia in pediatric patients with normal renal function.
- Children treated with hypotonic fluids for AGE-related dehydration did not develop hyponatremia.
Objective:
The purpose of this study is to analyse whether the use of hypotonic fluids increases the risk of iatrogenic hyponatraemia in children hospitalised with acute gastroenteritis (AGE).
Patients And Methods:
Prospective study carried out on 205 patients with ages ranging from 1 to 28 months and admitted with a diagnosis of mild or moderate dehydration due to AGE and treated with intravenous hypotonic fluids in a paediatric department in Madrid (Spain). The degree of dehydration at presentation was estimated using standard clinical measures. 198 children received 0.3 % glucosaline solution and in 7 patients, with baseline hypernatraemia, 0.2 % gluco-hyposaline solution was administered. We analysed the results according to whether children were hyponatraemic, normonatraemic or hypernatraemic at presentation. The blood and urine samples were analysed and the concentration of sodium and fractional sodium excretion (EFNa) before and after intervention were considered as outcome measures.
Results:
The 205 patients included in the study were distributed in 3 groups according to the baseline natraemia results. In 37 cases we detected hyponatraemia (18.04%), in 133 cases isonatraemia (64.87%) and in 35 children hypernatraemia (17.07%). After administering hypotonic fluids we detected a significant difference between initial and final natraemia in all groups; in the group with hyponatraemia, sodium increased and in the groups with iso and hypernatraemia, sodium slightly decreased. A significant correlation between the EFNa and the evolution of natraemia was found. No cases of hyponatraemia post-infusion were seen and there was no correlation between free water administered and natraemia evolution.
Conclusions:
RESULTS show that the use of hypotonic fluids does not increase the risk of hospital acquired hyponatraemia in hospitalised children with normal renal function. Our children with gastroenteritis did not develop hyponatraemia even though they were all treated with hypotonic intravenous solutions.
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