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Association Between Hyponatremia and Maintenance Intravenous Solutions in Critically Ill Children: A Retrospective
Jaime Fernández-Sarmiento1, Andrea Pérez2, Maria Alejandra Echeverri2
1Departament of Pediatrics and Intensive Care, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de La Sabana, Bogotá, Colombia.
Insights
Hypotonic intravenous solutions in pediatric intensive care are linked to a higher risk of hyponatremia in children, leading to longer hospital stays. Balanced isotonic solutions may reduce this risk.
Area of Science:
- Pediatric Intensive Care Medicine
- Clinical Chemistry
- Fluid and Electrolyte Balance
Background:
- Hyponatremia is a common electrolyte disorder in critically ill children.
- The type of maintenance intravenous fluids administered may influence the development of hyponatremia.
- Understanding this association is crucial for optimizing patient care in the pediatric intensive care unit (PICU).
Purpose of the Study:
- To investigate the association between different types of maintenance intravenous solutions and the incidence of hyponatremia in children admitted to the PICU.
- To identify risk factors for hyponatremia in this patient population.
Main Methods:
- An analytical observational study was conducted on children hospitalized in the PICU from January 2015 to December 2018.
- Included patients received maintenance fluids within 48 hours of admission and had at least two serum sodium levels measured.
- Data on fluid type, patient demographics, clinical characteristics, and outcomes were collected and analyzed.
Main Results:
- Of 503 eligible children, 24.1% developed hyponatremia.
- Hypotonic solutions were associated with a higher incidence of hyponatremia (63% vs. 37%) and longer hospital stays (mean difference of 8 days).
- Children receiving loop diuretics or who were post-operative had an increased risk of hyponatremia with hypotonic solutions. Balanced isotonic solutions were associated with a lower risk of hyponatremia and hyperchloremia.
Conclusions:
- Hyponatremia occurs in approximately one in four children in the PICU, often associated with hypotonic maintenance solutions.
- The use of hypotonic solutions is linked to prolonged hospitalization, particularly in post-operative patients and those on loop diuretics.
- Further clinical research is necessary to establish the most effective and safe maintenance fluid strategies for critically ill children.
Abstract:
Objetive: We sought to determine the association between maintenance intravenous solutions and the presence of hyponatremia in children in pediatric intensive care (PICU). Materials and Methods: An analytical observational study in children hospitalized in the PICU between January 2015 and December 2018. Patients who received maintenance fluids within the first 48 h after admission and who had at least two serum sodium levels drawn during this time were included. Measurements and Main Results: A total of 1,668 patients were admitted to the PICU during the study period, 503 of whom met the inclusion criteria. The median age was 24 months (IQR 8-96) and 50.9% were female. Altogether, 24.1% of the children developed hyponatremia; it was more frequent in those who received hypotonic solutions (63 vs. 37%; OR 1.41 95% CI 0.92, 2.15 p = 0.106), who also had a longer hospital stay (20 vs. 14 days, difference in means 8 days, 95% CI 2.67, 13.3, p = 0.001). Children who received loop diuretics and those who were post-operative had a greater risk of developing hyponatremia if they received hypotonic solutions (aOR 2.1 95% CI 1.41, 3.0, p = 0.000). Those with balanced isotonic solutions had a lower risk of developing hyponatremia (aOR 0.59 95% CI 0.35, 0.99, p = 0.004) and hyperchloremia (aOR 0.51 95% CI 0.34, 0.77, p = 0.000), adjusted for disease severity. A greater risk of death was found in the group with severe hyponatremia <130 mEq/L (aOR 9.75 95% CI 1.64-58.15; p = 0.01). Conclusions: Hyponatremia associated with the use of hypotonic maintenance solutions occurs in one out of four children in intensive care. The use of these solutions is associated with a longer hospital stay, and the main risk groups are post-operative patients and those who receive loop diuretics. Clinical studies are needed to determine which maintenance solutions have the greatest efficacy and safety in critically ill children.
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