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Comparison of Serum Sodium Levels Following Intravenous Administration of Isotonic and Hypotonic Solutions in Young
Nisara Chongcharoen1, Yupaporn Amornchaichareonsuk2, Suwanna Pornrattanarungsi3
1Department of Pediatrics, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand.
Insights
In pediatric patients under five, isotonic intravenous fluids (IVFs) better maintained serum sodium levels compared to hypotonic IVFs within 24 hours. This study found no increased risk of complications with isotonic fluids.
Area of Science:
- Pediatric critical care medicine
- Intravenous fluid therapy
- Electrolyte balance
Background:
- Intravenous fluid (IVF) administration is common in pediatric patients.
- The choice between isotonic and hypotonic fluids can impact electrolyte balance.
- Understanding the effects of different IVF solutions on serum sodium is crucial for patient safety.
Purpose of the Study:
- To compare the effects of isotonic versus hypotonic intravenous fluids (IVFs) on serum sodium (S Na) levels at 24 hours post-administration.
- To evaluate the incidence of dysnatremia and hyperchloremic metabolic acidosis in pediatric patients receiving different IVF solutions.
Main Methods:
- A double-blind, randomized controlled trial was conducted involving children aged 3 months to 5 years.
- Patients were assigned to receive either isotonic (D5 0.9% NaCl) or hypotonic (D5 0.45% NaCl) IVFs.
- Serum electrolytes and blood gas levels were monitored at baseline, 24 hours, and 48 hours.
Main Results:
- The change in serum sodium at 24 hours was significantly greater with isotonic fluids (2.97 mmol/L) compared to hypotonic fluids (2.19 mmol/L).
- No significant hyponatremia or hypernatremia occurred in either group.
- The incidence of hyperchloremic metabolic acidosis and other complications were similar between the groups.
Conclusions:
- Isotonic IVFs may be preferable for pediatric patients under five on general wards, particularly within the first 24 hours.
- Isotonic fluids appear to maintain serum sodium levels effectively without increasing risks of fluid overload or electrolyte complications.
- Further research may support isotonic fluids as a standard for specific pediatric populations.
Objectives:
This study evaluated changes in serum sodium (S Na) 24 h after the administration of isotonic versus hypotonic intravenous fluids (IVFs) and the incidences of dysnatremia and hyperchloremic metabolic acidosis.
Methods:
This double-blind, randomized controlled trial involved children aged 3 months to 5 years who were admitted to a general ward between November 2020 and September 2022 and required IVF. We randomly assigned patients (1:1) to receive either an isotonic solution (D50.9%NaCl) or hypotonic solution (D50.45%NaCl). Serum electrolyte and venous blood gas levels were obtained at the time of IVF administration and 24 and 48 h after IVF administration. During this study, all participants were monitored for vital signs, body weight, fluid intake and output, and clinical symptoms of dysnatremia.
Results:
Totals of 69 and 68 patients received isotonic and hypotonic solutions, respectively. The mean age was 1.95 ± 1.25 years in the isotonic group and 1.91 ± 1.32 years in the hypotonic group. The initial degrees of dehydration and biochemical indicators were not different. The change in serum sodium level at 24 h was 2.97 (2.32-3.62) mmol/L in the isotonic group and 2.19 (1.54-2.84) mmol/L in the hypotonic group. In both groups, no significant hyponatremia nor hypernatremia occurred. The incidence of hyperchloremic metabolic acidosis was not different between the groups. Neither group showed any complications.
Conclusions:
Isotonic fluids may be a preferred option for IVFs in pediatric patients under 5 years of age with medical conditions on a general ward, especially within 24 h, due to their potential to better maintain serum sodium levels without increasing the risk of fluid overload or electrolyte complication.
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