1581: HYPERCHLOREMIA AND AKI IN PEDIATRIC PATIENTS WITH TBI TREATED WITH HYPERTONIC SALINE INFUSION

Hyponatremia is one of the most common electrolyte abnormalities encountered in the clinical setting in hospitalized patients. The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the leading cause of hyponatremia in most of these cases. While fluid restriction, hypertonic saline infusion, diuretics, and the treatment of underlying conditions constitute the first line of treatment of SIADH, in refractory cases, and especially for pediatric patients, there seems not to be any other choice for treatment. Tolvaptan, although its use in pediatric patients is still very limited, might be an attractive treatment option for correction of hyponatremia due to SIADH. Here we present a pediatric case of SIADH that was resistant to treatment with fluid restriction and hypertonic saline infusion and was treated successfully with tolvaptan. Tolvaptan could be a good, safe, and effective treatment option in pediatric SIADH cases that are resistant to treatment. However, the dosage should be titrated carefully.

Download Full-text

Lidocaine coinfusion alleviates vascular pain induced by hypertonic saline infusion: a randomized, placebo-controlled trial

BMC Anesthesiology ◽

10.1186/s12871-021-01329-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhiping Song ◽

Shibiao Chen ◽

Yang Zhang ◽

Xiaoyun Shi ◽

Na Zhao ◽

...

Keyword(s):

Hypertonic Saline ◽

Saline Solution ◽

Time Slot ◽

Controlled Trial ◽

Saline Infusion ◽

Clinical Trial Registry ◽

Hypertonic Saline Solution ◽

Vas Scores ◽

Vascular Pain ◽

Hypertonic Saline Infusion

Abstract Background Hypertonic saline solution has been frequently utilized in clinical practice. However, due to the nonphysiological osmolality, hypertonic saline infusion usually induces local vascular pain. We conducted this study to evaluate the effect of lidocaine coinfusion for alleviating vascular pain induced by hypertonic saline. Methods One hundred and six patients undergoing hypertonic saline volume preloading prior to spinal anesthesia were randomly allocated to two groups of 53 each. Group L received a 1 mg/kg lidocaine bolus followed by infusion of 2 mg/kg/h through the same IV line during hypertonic saline infusion; Group C received a bolus and infusion of normal saline of equivalent volume. Visual analogue scale (VAS) scores of vascular pain were recorded every 4 min. Results The vascular pain severity in Group L was significantly lower than that in Group C for each time slot (P < 0.05). The overall incidence of vascular pain during hypertonic saline infusion in Group L was 48.0%, which was significantly lower than the incidence (79.6%) in Group C (P < 0.05). Conclusion Lidocaine coinfusion could effectively alleviate vascular pain induced by hypertonic saline infusion. Trial registration Chinese Clinical Trial Registry, number: ChiCTR1900023753. Registered on 10 June 2019.

Download Full-text

Reproducibility of osmotic and nonosmotic tests of vasopressin secretion in men

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.1991.260.3.r533 ◽

1991 ◽

Vol 260 (3) ◽

pp. R533-R539 ◽

Cited By ~ 5

Author(s):

C. J. Thompson ◽

P. Selby ◽

P. H. Baylis

Keyword(s):

Blood Glucose ◽

Linear Regression ◽

Hypertonic Saline ◽

Linear Regression Analysis ◽

Plasma Osmolality ◽

Saline Infusion ◽

Intraindividual Variation ◽

Insulin Tolerance ◽

Vasopressin Secretion ◽

Hypertonic Saline Infusion

We have studied the reproducibility of the thirst and arginine vasopressin (AVP) responses to osmotic and hypoglycemic stimulation in healthy volunteers undergoing repeat hypertonic (855 mmol/l) saline infusion and insulin tolerance tests (ITTs). Hypertonic saline infusion caused similar mean rises in plasma osmolality, AVP, and thirst on each occasion. Linear-regression analysis defined close relationships between the slopes (r = +0.72, P less than 0.05) and the abscissal intercepts (r = +0.89, P less than 0.001) of the regression lines relating plasma osmolality (Posmol) and plasma AVP (PAVP), and the group intraindividual component of the variance for the slopes and intercepts was 7 and 0.6%, respectively. There were close correlations between the slopes (r = +0.79, P less than 0.02) and the intercepts (r = +0.84, P less than 0.01) of the regression lines relating Posmol and thirst, and group intraindividual component of the variance was 14 and 0.7%, respectively. Hypertonic saline infusion was infused on four occasions in four subjects, and the results showed that the linear regression lines relating PAVP and Posmol and thirst and Posmol were reproducible within an individual. There were similar falls in blood glucose and elevations in PAVP in both ITTs. No relationship was defined between the fall in blood glucose and either the rise in PAVP or the area under the AVP curve (AUC). The intraindividual component of the variance for the rise in AVP and the AUC was 77 and 22.5%, respectively. The AVP and thirst responses to osmotic stimulation are highly reproducible, but there is considerable intraindividual variation in the AVP response to hypoglycemia.

Download Full-text