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Effect of Saline versus Gluconate/Acetate-Buffered Solution versus Lactate-Buffered Solution on Serum Chloride Among
Yunus Nadeemulla Beig Khader1, Sana Mehek2, Shubhanshu Gupta3
1Department of Pediatrics, Amana Healthcare, Al Ain, UAE.
Insights
Intravenous fluid composition impacts pediatric electrolytes. Balanced IV fluids, unlike saline, help maintain stable chloride levels and may prevent acidosis in children.
Area of Science:
- Pediatric critical care medicine
- Clinical chemistry
- Intravenous fluid therapy
Background:
- Intravenous (IV) fluid administration is a standard pediatric practice.
- 0.9% saline can cause hyperchloremia, leading to metabolic acidosis and kidney issues.
- Balanced IV solutions are emerging as safer alternatives.
Purpose of the Study:
- To compare serum chloride changes in hospitalized children receiving saline, gluconate/acetate-buffered, or lactate-buffered IV fluids.
Main Methods:
- Prospective observational study of 90 pediatric patients.
- Patients received one of three IV fluids: saline (n=30), gluconate/acetate-buffered (n=30), or lactate-buffered (n=30).
- Serum chloride measured at baseline and 24 hours; analyzed using ANOVA and paired t-tests.
Main Results:
- Post-infusion chloride levels were significantly higher in the saline group (107.2 ± 3.1 mmol/L) versus balanced solutions (gluconate/acetate: 103.5 ± 2.4 mmol/L; lactate: 102.9 ± 2.8 mmol/L) (P < 0.001).
- Saline administration resulted in the most significant chloride elevation.
- Trends toward mild acidosis were observed with saline use.
Conclusions:
- Pediatric saline use is linked to greater serum chloride increases than balanced IV fluids.
- Buffered IV fluids appear superior for maintaining pediatric electrolyte balance.
Background:
Intravenous (IV) fluid administration is routine in pediatric care, but fluid composition can significantly influence serum electrolyte levels. Hyperchloremia, often associated with 0.9% saline, may lead to metabolic acidosis and renal dysfunction. Balanced solutions, including gluconate/acetate-buffered and lactate-buffered fluids, are being explored for safer alternatives.
Objective:
To compare the effects of saline, gluconate/acetate-buffered, and lactate-buffered IV fluids on serum chloride levels in hospitalized children.
Materials And Methods:
A prospective observational study was conducted among pediatric in patients receiving one of three IV fluids: saline (n = 30), gluconate/acetate-buffered solution (n = 30), or lactate-buffered solution (n = 30). Serum chloride was measured at baseline and after 24 h of fluid administration. Statistical analysis was performed using ANOVA and paired t-tests.
Results:
Mean post-infusion chloride levels were significantly higher in the saline group (107.2 ± 3.1 mmol/L) compared to the gluconate/acetate group (103.5 ± 2.4 mmol/L) and lactate-buffered group (102.9 ± 2.8 mmol/L) (P < 0.001). Chloride elevation was most pronounced in the saline group, with associated trends toward mild acidosis.
Conclusion:
Saline use in children is associated with greater increases in serum chloride compared to balanced solutions. Buffered fluids may be preferable for maintaining electrolyte stability in pediatric fluid therapy.
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