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Life's biochemical processes occur within aqueous solutions. Solutes are substances that are dissolved within these solutions. The human body contains a variety of solutes, which can differ across various body parts. These can encompass proteins—such as those responsible for clotting and carbohydrate transport—as well as electrolytes. In medicine, an electrolyte is often described as a mineral ion derived from a salt possessing an electric charge. Examples include sodium ions...
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How to follow the guidelines, when the appropriate fluid is missing?

David W Brossier1,2,3,4, Isabelle Goyer5, Claire Morice6

  • 1CHU de Caen, Pediatric Intensive Care Unit, 14000, Caen, France. brossier-d@chu-caen.fr.

European Journal of Pediatrics
|March 18, 2024
PubMed
Summary

Glucose-containing balanced isotonic fluids are recommended for paediatric IV-MFT but are available to less than 25% of European and Middle Eastern clinicians. Availability varies significantly by country, impacting appropriate fluid therapy for children.

Keywords:
Balanced fluidsIntravenous fluidsIsotonic fluids

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Area of Science:

  • Pediatric critical care medicine
  • Clinical pharmacy
  • Fluid and electrolyte management

Background:

  • Intravenous maintenance fluid therapy (IV-MFT) is a cornerstone of pediatric hospital care.
  • Current guidelines recommend balanced isotonic fluids for IV-MFT in acute and critical pediatric settings.
  • The availability of ready-to-use glucose-containing balanced fluids is crucial for guideline adherence.

Purpose of the Study:

  • To assess the availability of glucose-containing balanced isotonic fluids in European and Middle Eastern pediatric acute and critical care settings.
  • To identify variations in availability across different countries and regions.
  • To understand the impact of availability on clinical practice.

Main Methods:

  • An ancillary study to a cross-sectional electronic survey.
  • A 27-item survey distributed to pediatric critical care physicians across 34 European and Middle Eastern countries.
  • Data collected on the availability of balanced isotonic fluid with 5% glucose.

Main Results:

  • Balanced isotonic fluid with 5% glucose was available to only 32% of responders (21%).
  • Availability was high in the UK (90%) but notably low in France, Greece, the Netherlands, and Turkey.
  • Availability varied significantly between countries and could be inconsistent within countries.

Conclusions:

  • Ready-to-use balanced isotonic IV solutions with glucose are inconsistently available across Europe and the Middle East.
  • This inconsistency challenges the implementation of evidence-based IV-MFT guidelines.
  • National and European initiatives are needed to ensure consistent availability of safe and appropriate IV-MFT solutions for all children.