Electrolyte derangements in critically ill children receiving balanced versus unbalanced crystalloid fluid...

Area of Science:

• Pediatric Critical Care Medicine
• Pediatric Resuscitation
• Pediatric Nephrology

Background:

• Adult studies suggest harm from 0.9% sodium chloride (0.9%NaCl) resuscitation, leading to increased use of balanced crystalloids like lactated Ringer's (LR).
• Theoretical safety concerns exist regarding LR's sodium and potassium content in pediatric populations, with limited existing data.
• This study addresses the gap in pediatric knowledge regarding fluid resuscitation choices.

Purpose of the Study:

• To investigate the association between fluid resuscitation with LR versus 0.9%NaCl and electrolyte derangements in critically ill children.
• To compare the incidence of acidosis in children receiving predominantly LR versus 0.9%NaCl for resuscitation.

Main Methods:

• A prospective, observational cohort study included critically ill children receiving ≥20 ml/kg fluid resuscitation.
• Patients were categorized into groups based on predominant fluid: 0.9%NaCl, LR, or a mixed fluid group.
• The primary outcome assessed was the incidence of electrolyte derangements (sodium, chloride, potassium) and acidosis.

Main Results:

• Of 559 patients, 297 received predominantly 0.9%NaCl, 74 received predominantly LR, and 188 received a mixture.
• Extreme hyperkalemia (potassium ≥ 6 mmol/L) was significantly more common in the 0.9%NaCl group (5.8%) than the LR group (0%, p<0.05).
• Extreme acidosis (pH > 7.1) was also more frequent in the 0.9%NaCl group (11%) compared to the LR group (1.6%, p<0.016).

Conclusions:

• Lactated Ringer's (LR) solution is associated with fewer electrolyte derangements and less acidosis compared to 0.9% sodium chloride (0.9%NaCl) in pediatric fluid resuscitation.
• These findings suggest a potential safety advantage for LR in critically ill children.
• Prospective interventional trials are recommended to validate these observational findings.