140 mmol/L of sodium versus 77 mmol/L of sodium in maintenance intravenous fluid therapy for children in hospital (PIMS): a randomised controlled double-blind trial

McNab, Sarah; Duke, Trevor; South, Mike; Babl, Franz E; Lee, Katherine J.; Arnup, Sarah; Young, Simon; Turner, H.; Davidson, Andrew

doi:10.1016/s0140-6736(14)61459-8

Cited by 146 publications

(120 citation statements)

References 37 publications

Supporting

Mentioning

114

Contrasting

Unclassified

Order By: Relevance

“…In this study 676 children (312 surgical patients) were randomized to receive either isotonic PlasmaLyte 148 or hypotonic 0.45 % saline. The incidence of hyponatremia (Na <135 mmol/L) was significantly less in the isotonic group (4%) than in the hypotonic group (11 %) (OR 0.31, 95 % CI 0.16-0.61, P=0.001) [30]. Unlike the aforementioned studies, the randomized, double-blinded study by Saba et al comparing 0.45 % saline and 0.9 % saline in 37 pediatric patients (25 surgical patients) did not show increased hyponatremic risk in the hypotonic group [31].…”

Section: Fluid Tonicity and Hyponatremiamentioning

confidence: 89%

“…In a large cohort study, children admitted with cardiology and Table 2 Composition of commonly used intravenous fluids hematology/oncology diagnoses were associated with more than a twofold greater risk of hospital-acquired hyponatremia [7]. The largest pediatric randomized controlled trial of isotonic versus hypotonic IV fluids conducted to date showed that the risk of hyponatremia was lower with isotonic fluids across heterogeneous groups of pediatric patients and that isotonic IV fluid decreased the risk of hyponatremia in both surgical patients (OR 0.32, 95% CI 0.12-0.82, P=0.02) and non-surgical patients (OR 0.32, 95% CI 0.12-0.85, P=0.02) [30]. These results clearly demonstrate that although surgery is an independent risk factor for developing hyponatremia, hypotonic fluids are associated with iatrogenic hyponatremia across the spectrum of pediatric disease.…”

Section: Fluid Tonicity and Hyponatremiamentioning

confidence: 99%

See 1 more Smart Citation

Perioperative fluid management and postoperative hyponatremia in children

Sutherland

2015

Pediatr Nephrol

View full text Add to dashboard Cite

Intravenous (IV) fluids are used ubiquitously when children undergo surgical procedures. Until recently, Holliday and Segar's guidelines for calculating maintenance fluids dictated fluid management strategies in postoperative pediatric patients. An increased recognition of hospitalacquired hyponatremia and its associated morbidity has led to a critical re-examination of IV fluid management in this population. Postsurgical patients are at high risk of developing hyponatremia due to the presence of non-osmotic stimuli for antidiuretic hormone release. Recent studies have established that, as they are administered in current practice, hypotonic maintenance fluids are associated with increased rates of hyponatremia. The best available data demonstrate that administration of isotonic fluid reduces hyponatremic risk. In this review, we discuss the collective data available on the subject and offer guidelines for fluid management and therapeutic monitoring.

show abstract

Section: Fluid Tonicity and Hyponatremiamentioning

confidence: 89%

Section: Fluid Tonicity and Hyponatremiamentioning

confidence: 99%

Perioperative fluid management and postoperative hyponatremia in children

Sutherland

2015

Pediatr Nephrol

View full text Add to dashboard Cite

show abstract

“…However, it is known today that in seriously ill children, energy consumption and therefore, water and electrolyte requirements, varies significantly according to multiple circumstances Thus, these general rules for the administration of maintenance intravenous fluid therapy may lead to harmful effects on these patients 2,3 , many of whom present a non-osmotic secretion of ADH, and therefore a limited ability to excrete water 10,11 . Many authors have related the administration of hypotonic fluids in hospitalized patients with an increased incidence of iatrogenic hyponatremia 1,3,4,6,7,11,12 with complications whose severity will depend on both the magnitude of hyponatremia and its onset speed, which could lead to permanent neurological injuries and death of the patient 2,4,6 . Despite the growing number of studies that suggest the use of isotonics, there is no consensus on this and even today some publications advocate the use of hypotonic fluids as maintenance fluid therapy 13,14 .…”

Section: Introductionmentioning

confidence: 99%

“…Despite the growing number of studies that suggest the use of isotonics, there is no consensus on this and even today some publications advocate the use of hypotonic fluids as maintenance fluid therapy 13,14 . The current trend is the recommendation of isotonic solutions routinely in hospitalized pediatric patients, given the growing evidence on their safety and the results of recent meta-analyses [12][13][14][15][16] reserving hypotonic solutions for specific cases 9,12 .…”

Section: Introductionmentioning

confidence: 99%

Hiponatremia adquirida en el hospital: ¿influye el tipo de fluidoterapia en los niños ingresados a cuidados intensivos?

Velasco

Romero

Oikonomopoulou

et al. 2018

Rev. chil. pediatr.

View full text Add to dashboard Cite

Introduction: The objective of this study was to evaluate the association between the type of initial fluid therapy used (isotonic or hypotonic solutions) and the development of hyponatremia, the plasma chlorine values and the tolerance of venous access. Patients and Method: Retrospective cohort study in a Pediatric Intensive Care Unit (PICU) of a high complexity hospital. There were included children younger than 15 years old hospitalized during the first semester of 2010 and 2013 who received intravenous maintenance fluid therapy, excluding patients undergoing cardiac surgery, kidney transplant and admissions that lasted less than 24 hours. Epidemiological, comorbidity and admission-related data were collected, including type of solution received, sodium and chlorine values in the first 72 hours of hospitalization and the incidence of extravasation of peripheral intravenous lines. Results: 111 children were included; 68 children (61.3%) were treated with hypotonic solutions and 43 (38.7%) with isotonic solutions. There were no differences in pathology and severity, and also in the volume of fluid received. Among the patients who received hypotonic solutions, 28 (41.2%) developed hyponatremia, wich was moderate (Na <130 mEq/Kg) in 11 cases, compared with 8 children (18.6%) who received isotonic solutions, with only one case of moderate hyponatremia (p = 0.027). No cases of hypernatremia were recorded, and there were no differences in plasma chlorine values. There was also no increased frequency of venous access loss in patients treated with isotonic solutions (4.7% versus 7.4%, p = 0.704). Conclusion: Treatment with initial isotonic solutions in children hospitalized in PICU is associated with a lower incidence and severity of hyponatremia, without changes in the plasma chlorine values and it is well tolerated by peripheral intravenous lines.

show abstract

“…12 Since our initial recommendation, there have been .15 randomized, prospective trials involving .2000 children confirming that hypotonic maintenance fluids result in hospital-acquired hyponatremia and that isotonic fluids decrease the incidence of hyponatremia without associated complications. [13][14][15][16] It would be reasonable to conclude that hypotonic fluids should be avoided in infants with bronchiolitis in favor of 0.9% saline, because bronchiolitis is associated with SIADH. 2,[17][18][19][20] However, surprisingly few studies have examined IVF prescribing practices in bronchiolitis or the impact of the sodium composition on the development of hyponatremia and how these fluids may affect outcome.…”

mentioning

confidence: 99%

How to Improve Maintenance Intravenous Fluid Prescribing Practices in Bronchiolitis

Moritz

Ayus

2017

Hospital Pediatrics

View full text Add to dashboard Cite

Bronchiolitis is the most common reason for hospitalization in infants in the first year of life. 1 There are no proven therapies to treat this common condition, with the mainstay of therapy being supportive care with intravenous fluid (IVF) and supplemental oxygen when needed. Hyponatremia is often encountered in children with bronchiolitis and has been associated with more severe disease and worse outcomes, and neurologic complications have been reported. 2-6 Explicit recommendations for IVF therapy in children with bronchiolitis are lacking in both consensus guidelines and authoritative reviews. [7][8][9] The historical approach to providing maintenance fluids in children has been to administer hypotonic IVF with a sodium concentration similar to that found in breast and cow milk (30 mEq/L). 10 In 2003, we began recommending 0.9% saline in 5% dextrose for the prevention of hospital-acquired hyponatremia, based on numerous reports of iatrogenic deaths related to hypotonic fluids and the incidence of syndrome of inappropriate secretion of antidiuretic hormone (SIADH)-like states in acutely ill children. 11 A 0.9% saline solution has a sodium concentration (154 mEq/L), which is isotonic to the aqueous phase of plasma water. 12 Since our initial recommendation, there have been .15 randomized, prospective trials involving .2000 children confirming that hypotonic maintenance fluids result in hospital-acquired hyponatremia and that isotonic fluids decrease the incidence of hyponatremia without associated complications. 13-16 It would be reasonable to conclude that hypotonic fluids should be avoided in infants with bronchiolitis in favor of 0.9% saline, because bronchiolitis is associated with SIADH. 2,17-20 However, surprisingly few studies have examined IVF prescribing practices in bronchiolitis or the impact of the sodium composition on the development of hyponatremia and how these fluids may affect outcome. 21In this issue of Hospital Pediatrics, Shein et al evaluated how the sodium composition of IVF may affect the development of hyponatremia and outcome in children with bronchiolitis. 22 They evaluated a large retrospective cohort of .1500 children, comparing those who received maintenance IVF with a sodium concentration ,70 mEq/L with those .70 mEq/L. They found that children with hyponatremia had an increased length of stay and higher need for mechanical ventilation. Those who received a more hypotonic fluid, ,70 mEq/L, had both an increased length of stay and a significantly increased incidence of hyponatremia. These data demonstrated the deleterious effects that both hyponatremia and the administration of hypotonic IVF have on children with bronchiolitis. One area of this study that we would like to draw particular attention to is the ongoing pervasive practice of administering hypotonic maintenance IVF, even to the sickest children who are in the ICU on mechanical ventilation.

show abstract

140 mmol/L of sodium versus 77 mmol/L of sodium in maintenance intravenous fluid therapy for children in hospital (PIMS): a randomised controlled double-blind trial

Cited by 146 publications

References 37 publications

Perioperative fluid management and postoperative hyponatremia in children

Perioperative fluid management and postoperative hyponatremia in children

Hiponatremia adquirida en el hospital: ¿influye el tipo de fluidoterapia en los niños ingresados a cuidados intensivos?

How to Improve Maintenance Intravenous Fluid Prescribing Practices in Bronchiolitis

Contact Info

Product

Resources

About