Fluid administration − Which direction?

  • Sara Vaz Pediatric Intensive Care Unit, Pediatrics Department, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte; Centro Académico de Medicina de Lisboa; Pediatrics Department, Hospital de Santo Espírito da Ilha Terceira http://orcid.org/0000-0003-4964-2429
  • Sofia Cochito Sousa Pediatric Intensive Care Unit, Pediatrics Department, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte; Centro Académico de Medicina de Lisboa
  • Francisco Abecasis Pediatric Intensive Care Unit, Pediatrics Department, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte; Centro Académico de Medicina de Lisboa. http://orcid.org/0000-0002-1883-050X
  • Leonor Boto Pediatric Intensive Care Unit, Pediatrics Department, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte; Centro Académico de Medicina de Lisboa
  • Joana Rios Pediatric Intensive Care Unit, Pediatrics Department, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte; Centro Académico de Medicina de Lisboa
  • Cristina Camilo Pediatric Intensive Care Unit, Pediatrics Department, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte; Centro Académico de Medicina de Lisboa http://orcid.org/0000-0001-9619-9744
  • Marisa Vieira Pediatric Intensive Care Unit, Pediatrics Department, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte; Centro Académico de Medicina de Lisboa
Keywords: Acid-base imbalance, Fluids, Hyperchloremia, Hyponatremia, Metabolic acidosis, Water-electrolyte imbalance

Abstract

Introduction: Although fluid administration for intravenous hydration is a common practice in pediatric age, it is not devoid of risks.
Methods: This was a retrospective cohort study including all children admitted to surgical recovery and receiving intravenous hydration at a Pediatric Intensive Care Unit between January and December 2015. Sodium, chloride, and base excess values were registered on two occasions: after surgery and during Unit’s hospitalization.
Results: Two hundred and seven children were included in the study, 66% of which, male, with a median age of 6.7 years. Fluids used consisted of 0.9% saline solution, 0.45% saline solution, and polyelectrolyte solution. The most frequently used fluids were polyelectrolyte (62%) and 0.9% saline solution (48%) at the operating room, and 0.9% saline (63%) and 0.45% saline (44%) solutions at the Pediatric Intensive Care Unit. At the operating room, 0.9% saline solution led to higher chloride median values and more negative base excess (metabolic acidosis) values compared with polyelectrolyte solution. At the Pediatric Intensive Care Unit, 0.9% saline solution administration resulted in hyperchloremia (p=0.002) and more metabolic acidosis (p=0.019) compared with 0.45% saline solution. There was no statistically significant association between type of solution used and sodium values.
Discussion: This study shows that the use of 0.9% saline solution is associated with development of hyperchloremic acidosis. This suggests that replacement of 0.9% saline solution with a plasma-like electrolyte solution may improve patient outcomes.

 

Author Biographies

Sara Vaz, Pediatric Intensive Care Unit, Pediatrics Department, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte; Centro Académico de Medicina de Lisboa; Pediatrics Department, Hospital de Santo Espírito da Ilha Terceira
 
Sofia Cochito Sousa, Pediatric Intensive Care Unit, Pediatrics Department, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte; Centro Académico de Medicina de Lisboa
                 
Francisco Abecasis, Pediatric Intensive Care Unit, Pediatrics Department, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte; Centro Académico de Medicina de Lisboa.
               
Leonor Boto, Pediatric Intensive Care Unit, Pediatrics Department, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte; Centro Académico de Medicina de Lisboa
             
Joana Rios, Pediatric Intensive Care Unit, Pediatrics Department, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte; Centro Académico de Medicina de Lisboa
           
Cristina Camilo, Pediatric Intensive Care Unit, Pediatrics Department, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte; Centro Académico de Medicina de Lisboa
         
Marisa Vieira, Pediatric Intensive Care Unit, Pediatrics Department, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte; Centro Académico de Medicina de Lisboa
       

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Published
2018-12-28
Section
Original Articles