Dataset Information

Hospital-Acquired Hyponatremia in Children Following Hypotonic versus Isotonic Intravenous Fluids Infusion.

ABSTRACT: Hypotonic solutions have been used in pediatrics for maintenance of intravenous (IV) hydration. However, recent randomized control trials and cohort studies have raised significant concerns for association with hospital-acquired hyponatremia (HAH). The study aimed to assess whether the use of hypotonic parenteral solutions (PS) compared with isotonic PS is associated with increased HAH risk in children with common pediatric conditions. Retrospective chart review of 472 patients aged 2 months to 18 years who received either isotonic or hypotonic PS as maintenance fluids. Administration of hypotonic PS was associated with a four-fold increase in risk of developing HAH in the univariate analysis, (unadjusted odds ratio (OR) = 3.99; 95% confidence interval (CI): 1.36⁻11.69, p = 0.01). Hypotonic PS were associated with HAH (p = 0.04) when adjusted for the level of admission serum CO₂. There was a mean decrease of serum sodium of 0.53 mEq/L in the hypotonic group compared to the mean increase of 4.88 mEq/L in the isotonic group. These data suggest that hypotonic PS are associated with HAH in children admitted for common pediatric conditions. Isotonic PS should be considered as a safer choice for maintenance fluid hydration.

SUBMITTER: Karageorgos SA

PROVIDER: S-EPMC6209932 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Hospital-Acquired Hyponatremia in Children Following Hypotonic versus Isotonic Intravenous Fluids Infusion.

Karageorgos Spyridon A SA Kratimenos Panagiotis P Landicho Ashley A Haratz Joshua J Argentine Louis L Jain Amit A McInnes Andrew D AD Fisher Margaret M Koutroulis Ioannis I

Children (Basel, Switzerland) 20181002 10

Hypotonic solutions have been used in pediatrics for maintenance of intravenous (IV) hydration. However, recent randomized control trials and cohort studies have raised significant concerns for association with hospital-acquired hyponatremia (HAH). The study aimed to assess whether the use of hypotonic parenteral solutions (PS) compared with isotonic PS is associated with increased HAH risk in children with common pediatric conditions. Retrospective chart review of 472 patients aged 2 months to ...[more]

PMID: 30279348

Similar Datasets

Project description:BackgroundIatrogenic hyponatremia is a common complication following intravenous maintenance fluid therapy (IV-MFT) in hospitalized children. Despite the American Academy of Pediatrics' 2018 recommendations, IV-MFT prescribing practices still vary considerably.ObjectivesThis meta-analysis aimed to compare the safety and efficacy of isotonic versus hypotonic IV-MFT in hospitalized children.Data sourcesWe searched PubMed, Scopus, Web of Science, and Cochrane Central from inception to October 1, 2022.Study eligibility criteriaWe included randomized controlled trials (RCTs) comparing isotonic versus hypotonic IV-MFT in hospitalized children, either with medical or surgical conditions. Our primary outcome was hyponatremia following IV-MFT. Secondary outcomes included hypernatremia, serum sodium, serum potassium, serum osmolarity, blood pH, blood sugar, serum creatinine, serum chloride, urinary sodium, length of hospital stay, and adverse outcomes.Study appraisal and synthesis methodsRandom-effects models were used to pool the extracted data. We performed our analysis based on the duration of fluid administration (i.e., ≤ 24 and > 24 h). The Grades of Recommendations Assessment Development and Evaluation (GRADE) scale was used to evaluate the strength and level of evidence for recommendations.ResultsA total of 33 RCTs, comprising 5049 patients were included. Isotonic IV-MFT significantly reduced the risk of mild hyponatremia at both ≤ 24 h (RR = 0.38, 95% CI [0.30, 0.48], P < 0.00001; high quality of evidence) and > 24 h (RR = 0.47, 95% CI [0.37, 0.62], P < 0.00001; high quality of evidence). This protective effect of isotonic fluid was maintained in most examined subgroups. Isotonic IV-MFT significantly increased the risk of hypernatremia in neonates (RR = 3.74, 95% CI [1.42, 9.85], P = 0.008). In addition, it significantly increased serum creatinine at ≤ 24 h (MD = 0.89, 95% CI [0.84, 0.94], P < 0.00001) and decreased blood pH (MD = -0.05, 95% CI [-0.08 to -0.02], P = 0.0006). Mean serum sodium, serum osmolarity, and serum chloride were lower in the hypotonic group at ≤ 24 h. The two fluids were comparable in terms of serum potassium, length of hospital stay, blood sugar, and the risk of adverse outcomes.LimitationsThe main limitation of our study was the heterogeneity of the included studies.Conclusions and implications of key findingsIsotonic IV-MFT was superior to the hypotonic one in reducing the risk of iatrogenic hyponatremia in hospitalized children. However, it increases the risk of hypernatremia in neonates and may lead to renal dysfunction. Given that the risk of hypernatremia is not important even in the neonates, we propose to use balanced isotonic IV-MFT in hospitalized children as it is better tolerated by the kidneys than 0.9% saline.Systematic review registration numberCRD42022372359. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information.

Project description:Hyponatraemia is a known complication in hospitalised children receiving maintenance intravenous fluid. Several studies have been published to investigate the efficacy and safety of intravenous fluids in children. However, there is still an ongoing debate regarding the ideal solution to be used in the paediatric population. Therefore, the aim of this meta-analysis was to investigate the safety and efficacy of administering isotonic versus hypotonic intravenous maintenance fluid in hospitalised children. An extensive search was undertaken on PubMed, Web of Science, Scopus, ScienceDirect, Google Scholar and Cochrane Library on 28 December 2020. Only randomised controlled trials (RCTs) were included. We used the random-effects model for all analyses. Risk ratio (RR) and mean difference with 95% confidence intervals (CIs) were used for dichotomous and continuous outcomes, respectively. The quality of each study was assessed using the Joanna Briggs Institute critical appraisal tool for RCTs. This study is registered with PROSPERO (CRD42021229067). Twenty-two RCTs with a total of 3795 participants were included. The studies encompassed surgical and medical patients admitted to intensive care unit as well as to general wards. We found that hypotonic fluid significantly increases the risk of hyponatremia at both ≤24 h (RR 0.34; 95% CI: 0.26-0.43, p < 0.00001) and >24 h (RR 0.48; 95% CI: 0.36-0.64, p < 0.00001). Isotonic fluid increases the risk of hypernatraemia at ≤24 h (RR 2.15; 95% CI: 1.24-3.73, p = 0.006). The prevalence of hyponatraemia was also higher in the hypotonic group at both ≤24 h (5.7% vs. 23.3%) and >24 h (6.0% vs. 26.3%). There was no statistically significant difference in the risk of developing adverse outcomes between the two groups. Mean serum and urine sodium as well as serum osmolality/osmolarity was lower in the hypotonic group. Isotonic solution is protective against the development of hyponatraemia while hypotonic solution increases the risk of hyponatraemia.

Project description:BackgroundWhether intraoperative isotonic balanced maintenance fluid is associated with less variation in sodium homeostasis in small children undergoing major neurosurgery remains unknown.MethodsPatients aged up to 6 years undergoing major neurosurgery were randomly assigned to receive either isotonic balanced solution (IB) or 0.2% hypotonic solution (H) as intraoperative maintenance fluid. Serum electrolyte levels were measured from preoperative baseline to 6 d following surgery.ResultsEighty patients were included in the primary analysis. Serum sodium change was significantly less in the IB patients from the end of surgery continuing to 24 h following surgery (at the end of surgery: -1.4 ± 3.6 versus - 4.6 ± 3.5 mmol/l, P < 0.001; 24 h post: -1.2 ± 4.8 versus - 3.4 ± 2.5 mmol/l, P = 0.028). Twenty (50%) of the IB patients and 25 (63%) of the H patients had serum sodium change > 2.5 mmol/l 24 h following surgery (6.0 ± 3.4 versus 4.8 ± 2.1 mmol/l), with 13 (33%) of the IB patients and 25 (63%) of the H patients having sodium decrease > 2.5 mmol/l (6.4 ± 3.7 versus 4.8 ± 2.1 mmol/l) (P = 0.007). Seven patients in group IB experienced an increase in blood sodium levels exceeding 2.5 mmol/l (median, 4.1 [range 2.7 ∼ 9.2] mmol/l). Notably, 10 (25%) of the IB patients and 6 (15%) of the H patients had sodium variation > 5 mmol/l (median, 8.5 [range 5.1 ∼ 14.6] versus 7.2 [range 5.5 ∼ 11.1] mmol/l). Immediately following surgery till 24 h postoperatively, hyponatremia was less observed in the IB patients compared with that in the H patients. The IB patients had higher hemoglobin levels and less diuresis 48 h postoperatively. No symptoms including altered mental status, seizure, and circulatory overload were observed in all patients.ConclusionIntraoperative isotonic balanced solution infusion resulted in statistically but not clinically minimal variation of sodium homeostasis and hemoglobin level postoperatively in small children undergoing major neurosurgery, compared to the use hypotonic solution. Potentially excessive sodium fluctuation following isotonic balanced maintenance fluid infusion should be cautioned, even for a brief period of infusion.Trial registrationChinese Clinical Trial Registry ( http://www.chictr.org.cn/ ).Registration numberChiCTR2100046539. Registration date: May 21, 2021. Principal investigator: Lin-Lin Song.

Dataset Information

Hospital-Acquired Hyponatremia in Children Following Hypotonic versus Isotonic Intravenous Fluids Infusion.

Publications

Hospital-Acquired Hyponatremia in Children Following Hypotonic versus Isotonic Intravenous Fluids Infusion.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets