Dataset Information

Electrolyte-based calculation of fluid shifts after infusing 0.9% saline in severe hyperglycemia.

ABSTRACT:

Background

Early treatment of severe hyperglycemia involves large shifts of body fluids that entail a risk of hemodynamic instability. We studied the feasibility of applying a new electrolyte equation that estimates the degree of volume depletion and the distribution of infused 0.9% saline in this setting.

Methods

The new equation was applied to plasma and urinary concentrations of sodium and chloride measured before and 30?min after a 30-min infusion of 1?L of 0.9% saline on two consecutive days in 14 patients with severe hyperglycemia (mean age 50?years). The extracellular fluid (ECF) volume was also estimated based on the volume dilution kinetics of chloride.

Results

On day 1, the baseline ECF volume amounted to 11.5?L. The saline infusion expanded the ECF space by 160?mL and the intracellular fluid space by 375?mL. On day 2, the ECF volume was 15.5?L, and twice as much of the infused fluid remained in the ECF space. The chloride dilution kinetics yielded baseline ECF volumes of 11.6 and 15.2?L on day 1 and day 2, respectively. No net uptake of glucose to the cells occurred during the two 1-h measurement periods despite insulin administration in the intervening time period.

Conclusions

The electrolyte equation was feasible to apply in a group of hyperglycemic patients. The ECF space was 3?L smaller than expected on admission but normal on the second day. Almost half of the infused fluid was distributed intracellularly.

SUBMITTER: Svensson R

PROVIDER: S-EPMC7554273 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Electrolyte-based calculation of fluid shifts after infusing 0.9% saline in severe hyperglycemia.

Svensson Robert R Zdolsek Joachim J Malm Marcus M Hahn Robert G RG

Intensive care medicine experimental 20201013 1

<h4>Background</h4>Early treatment of severe hyperglycemia involves large shifts of body fluids that entail a risk of hemodynamic instability. We studied the feasibility of applying a new electrolyte equation that estimates the degree of volume depletion and the distribution of infused 0.9% saline in this setting.<h4>Methods</h4>The new equation was applied to plasma and urinary concentrations of sodium and chloride measured before and 30 min after a 30-min infusion of 1 L of 0.9% saline on two ...[more]

PMID: 33048297

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Project description:IntroductionBronchiolitis is an acute viral infection of the lower respiratory tract. It is most commonly caused by respiratory syncytial virus. Being a common reason for hospitalisation, it affects 13-17% of all hospitalised children younger than 2 years. Only supportive therapy, including suctioning nasal secretions, water-electrolyte balance maintenance and oxygen supplementation when needed, is recommended. However, non-evidence-based diagnostic and therapeutic approaches, including the use of inhaled bronchodilators, nebulised epinephrine, and nebulised and systemic steroids, are common. The inhalation of 3% hypertonic saline is not recommended in bronchiolitis management. However, a recently published meta-analysis revealed that the inhalation of hypertonic saline can reduce the risk of hospitalisation for outpatients with bronchiolitis, while resulting in a shorter length of hospital stay and reduced severity of respiratory distress for inpatients, although the evidence is of low certainty. We aim to assess the efficacy of nebulised hypertonic saline for the treatment of children hospitalised with bronchiolitis.Methods and analysisThis will be a randomised, double-blinded, parallel-group, controlled trial. Children younger than 2 years who are hospitalised due to bronchiolitis will be recruited from at least three paediatric departments in Poland. Bronchiolitis is defined as an apparent viral respiratory tract infection associated with airway obstruction that is manifested by at least one of following symptoms: tachypnoea, increased respiratory effort, crackles and/or wheezing. A total of 140 children will be randomised (1:1) to receive either hypertonic saline nebulisation (5 mL, three times a day) or normal saline at the same dose. The primary outcome measure will be the duration of hospitalisation.Ethics and disseminationThe Bioethics Committee of the Lower Silesia Medical Chamber in Wroclaw approved the study protocol (4/PNDR/2023). Caregivers will receive oral and written information about the study and written informed consent will be obtained by the study physicians. The findings of the study will be submitted to a peer-reviewed journal, and abstracts will be submitted to relevant national and international conferences.Trial registration numberClinicalTrials.gov Registry (NCT06069336).

Dataset Information

Electrolyte-based calculation of fluid shifts after infusing 0.9% saline in severe hyperglycemia.

Background

Methods

Results

Conclusions

Publications

Electrolyte-based calculation of fluid shifts after infusing 0.9% saline in severe hyperglycemia.

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