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Do we overestimate intravenous fluid therapy needs? Adverse effects related to isotonic solutions during pediatric

Jimena Pérez-Moreno1, Ana Gutiérrez-Vélez1, Laura Torres Soblechero1

  • 1Hospitalización de Pediatría, Servicio de Pediatría y sus Áreas Específicas, Hospital General Universitario Gregorio Marañón, Madrid, Spain.

Nefrologia
|March 12, 2023
PubMed

Insights

Isotonic fluid therapy in hospitalized children can cause adverse effects like hyperchloremia and edema, particularly in younger patients. Careful monitoring of infusion rates is crucial to minimize these risks in pediatric care.

Area of Science:

  • Pediatric Medicine
  • Clinical Pharmacology
  • Nephrology

Background:

  • Intravenous fluid therapy is a common intervention for hospitalized pediatric patients.
  • Isotonic fluids are frequently administered, but potential adverse effects require investigation.

Purpose of the Study:

  • To describe the adverse effects of isotonic fluid therapy in hospitalized children.
  • To determine the prevalence of these adverse effects based on the rate of fluid infusion.

Main Methods:

  • A prospective observational study included 84 pediatric patients (3 months-15 years).
  • Patients received 0.9% isotonic solutions with 5% glucose.
  • Fluid administration was categorized as restricted (<100% maintenance) or standard (≈100% maintenance).
  • Clinical and laboratory data were collected at admission (T0) and 24 hours (T1).

Main Results:

  • Hyperchloremia (>110 mEq/L) occurred in 16.6% of patients, and edema in 19%.
  • Edema was significantly more frequent in younger children (p < 0.01).
  • Hyperchloremia at 24 hours was an independent risk factor for developing edema (OR 1.73).

Conclusions:

  • Isotonic fluid therapy carries risks, including hyperchloremia and edema, especially in infants.
  • The rate of fluid infusion may contribute to adverse events.
  • Further research is needed to optimize intravenous fluid management in hospitalized children.
Abstract

Keywords:
Adverse effectsEdemaEfecto adversoFluidoterapia intravenosaFluidoterapia isotónicaHospitalización pediátricaIntravenous infusionsIsotonic solutionsOedemaPaediatric hospitalizationPaediatricsPediatría

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