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Suitable intravenous fluid for preventing dysnatremia in children with gastroenteritis; a randomized clinical trial
Kioomars Golshekan1, Hamidreza Badeli1, Mahboube Miri1
1Pediatrics Growth Disorders Research Center, 17 Shahrivar Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
Insights
Isotonic saline effectively treats hyponatremia in children with gastroenteritis (GE). This study suggests using isotonic fluids for all GE patients, simplifying treatment decisions and preventing dysnatremia.
Area of Science:
- Pediatric Emergency Medicine
- Pediatric Nephrology
- Clinical Trials
Background:
- Gastroenteritis (GE) is a leading cause of pediatric hospitalizations.
- Hyponatremia frequently develops in children with GE due to hypotonic fluid administration.
- Current treatment guidelines for dysnatremia in pediatric GE lack consensus.
Purpose of the Study:
- To evaluate the efficacy of isotonic saline in preventing and treating dysnatremia in pediatric patients with gastroenteritis.
- To compare the effects of isotonic versus hypotonic saline maintenance fluids on serum sodium levels.
- To provide evidence-based recommendations for intravenous fluid selection in pediatric GE.
Main Methods:
- A double-blind, randomized clinical trial involving children aged 6 months to 14 years with GE.
- Patients were randomized to receive either 0.9% isotonic saline or 0.45% hypotonic saline as maintenance and deficit fluid after an initial isotonic bolus.
- Serum and urine sodium levels were monitored at baseline, 4 hours, and 24 hours.
Main Results:
- No significant difference in mean serum sodium levels was observed between the groups at 4 and 24 hours post-administration.
- Isotonic saline administration showed a significant improvement in serum sodium levels in patients with baseline hyponatremia.
- No cases of hypernatremia were reported in the group receiving isotonic saline.
Conclusions:
- Isotonic saline administration appears to be a safe and effective fluid for managing pediatric gastroenteritis, regardless of initial hydration status.
- The findings support the use of isotonic fluids to simplify treatment decisions and prevent dysnatremia in children with GE.
- Further research may confirm isotonic saline as a preferred fluid for pediatric gastroenteritis management.
Introduction:
Gastroenteritis (GE) is one of the most common pediatric diseases. Hyponatremia commonly occurs by administering hypotonic fluids to GE and hospitalized children. Yet, there is no consensus on the ideal method of treatment.
Objectives:
we aimed to assess suitable intravenous (IV) fluid for preventing dysnatremia in children with GE.
Patients And Methods:
This is a double blind randomized clinical trial, which was conducted on infants of 6 months up to 14 years children with GE. Children were randomly assigned in 2 different groups. Group A; received 20 cc/kg 0.9% isotonic saline as a bolus, and 0.45% hypotonic saline as sum of maintenance fluid and volume deficit. Group B was treated with the same bolus and 0.9% isotonic saline with 20 mEq/L KCl as sum of maintenance fluid and volume deficit. Blood and urine samples were taken at admission, 4 and 24 hours. Data were analyzed by independent t test, Mann-Whitney U test, Friedmann test, chi-square and 2-tailed repeated measurements by SPSS version 19.
Results:
Baseline hyponatremia and isonatremia were detected in 24 (31.5%) and 51 (67.1%) patients, respectively. Mean level of sodium at T0, T4 and T 24 mentioned no significant difference between groups. No hypernatremia was noted by administering isotonic saline. RESULTS showed that 4 and 24 hours after administration isotonic saline, the mean plasma sodium differed significantly in baseline hyponatremic patients. However, no significant difference was noted after 4 and 24 hours in group A.
Conclusion:
According to the considerable effect of isotonic saline on hyponatremic patients, it seems that administering isotonic fluids regardless of the types of dysnatremia can be recommended to lessen clinicians' conflicting decision-making in selecting an appropriate fluid.
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