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Hypotonic versus isotonic maintenance fluids in critically ill children: a multicenter prospective randomized study.

Abstract

AIM
Study the influence of hypotonic (HT) and isotonic (IT) maintenance fluids in the incidence of dysnatraemias in critically ill children.
METHODS
Prospective, randomized study conducted in three paediatric intensive care units (PICU). One hundred and twenty-five children requiring maintenance fluid therapy were included: 62 received HT fluids (50-70 mmol/L tonicity) and 63 IT fluids (156 mmol/L tonicity). Age, weight, cause of admission, sodium and fluid intake, and diuresis were collected. Blood electrolytes were measured on admission, 12 and 24 h later.
RESULTS
Blood sodium levels at 12 h were 133.7±2.7 mmol/L in HT group vs. 136.8±3.5 mmol/L in IT group (p=0.001). Adjusted for age, weight and sodium level at PICU admission, the blood sodium values of patients receiving HT fluids decrease by 3.22 mmol/L (CI: 4.29/2.15)(p=0.000). Adjusted for age, weight and hyponatraemia incidence at admission, patients receiving HT fluids increased the risk of hyponatraemia by 5.8-fold (CI: 2.4-14.0) during the study period (p=0.000).
CONCLUSIONS
Hypotonic maintenance fluids increase the incidence of hyponatraemia because they decrease blood sodium levels in normonatraemic patients. IT maintenance fluids do not increase the incidence of dysnatraemias and should be considered as the standard maintenance fluids.

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  • Publisher Full Text
  • Authors

    Rey C, Los-Arcos M, Hernández A, Sánchez A, Díaz JJ, López-Herce J

    Source

    Acta paediatrica (Oslo, Norway : 1992) 100:8 2011 Aug pg 1138-43

    MeSH

    Child
    Critical Illness
    Fluid Therapy
    Humans
    Hyponatremia
    Hypotonic Solutions
    Infusions, Intravenous
    Intensive Care Units, Pediatric
    Isotonic Solutions

    Pub Type(s)

    Comparative Study
    Journal Article
    Multicenter Study
    Randomized Controlled Trial

    Language

    eng

    PubMed ID

    21352357