scholarly journals Hyponatraemia despite isotonic maintenance fluid therapy: a time series intervention study

2020 ◽  
pp. archdischild-2019-318555
Author(s):  
Milan Chromek ◽  
Åsa Jungner ◽  
Niclas Rudolfson ◽  
David Ley ◽  
Detlef Bockenhauer ◽  
...  
Keyword(s):  
Time Series ◽  
Fluid Therapy ◽  
Intervention Study ◽  
Sodium Concentration ◽  
Paediatric Surgery ◽  
Maintenance Fluid ◽  
Before And After ◽  
Maintenance Fluid Therapy ◽  
Consecutive Time ◽  
Maintenance Fluids

ObjectiveTo examine the prevalence of dysnatraemias among children admitted for paediatric surgery before and after a change from hypotonic to isotonic intravenous maintenance fluid therapy.DesignRetrospective consecutive time series intervention study.SettingPaediatric surgery ward at the Children’s Hospital in Lund, during a 7-year period, 2010–2017.PatientsAll children with a blood sodium concentration measurement during the study period were included. Hypotonic maintenance fluid (40 mmol/L NaCl and 20 mmol/L KCl) was used during the first 3 years of the study (646 patients), and isotonic solution (140 mmol/L NaCl and 20 mmol/L KCl) was used during the following period (807 patients).Main outcome measuresPrimary outcomes were sodium concentration and occurrence of hyponatraemia (<135 mmol/L) or hypernatraemia (>145 mmol/L).ResultsOverall, the change from hypotonic to isotonic intravenous maintenance fluid therapy was associated with a decreased prevalence of hyponatraemia from 29% to 22% (adjusted OR 0.65 (0.51–0.82)) without a significantly increased odds for hypernatraemia (from 3.4% to 4.3%, adjusted OR 1.2 (0.71–2.1)). Hyponatraemia <130 mmol/L decreased from 6.2% to 2.6%, and hyponatraemia <125 mmol/L decreased from 2.0% to 0.5%.ConclusionsRoutine use of intravenous isotonic maintenance fluids was associated with lower prevalence of hyponatraemia, although hyponatraemia still occurred in over 20% of patients. We propose that the composition and the volume of administered fluid need to be addressed.

Comparison between Glucose Containing Solution D2.5% and Ringer Lactate as a Maintenance Fluid Management in Infants Undergoing Inguinal Hernia Repair

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed Hosny Hasan Mohamed ◽  
Dalia Abd El Hameed Mohamad Nasr ◽  
Amin Mohamed El Ansary
Keyword(s):  
Body Weight ◽  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Fluid Therapy ◽  
Fluid Management ◽  
The Other ◽  
Ringer Lactate ◽  
Maintenance Fluid ◽  
Maintenance Fluid Therapy

Abstract Background Infants and neonates are at particular risk of hypoglycemia when suffering from sepsis, asphyxia and hypothermia. A prospective study showed that up to 20% of preterm infants who were ready for discharge were still at risk of hypoglycemia when a feed was delayed. In contrast, surgery and critical illness may cause hyperglycemia. Objectives The aim of this study is to Assessment of glucose containing solutions 2.5 % as a maintenance fluid management intra operative in infants undergoing hernia repair as regard hyperglycemia and hypoglycemia. Patients and Methods The study was conducted on 100 randomly chosen patients aged from 28 days to 1 year, American Society of Anesthesiologists (ASA) class I scheduled for elective open inguinal hernia repair in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 50 patients each: Ringer lactate Group: patients received ringer lactate as maintenance fluid therapy according to body weight, glucose containing solution: patients received glucose containing solution 2.5% as maintenance fluid therapy according to body weight. Results The results of the study revealed that 12% of patients receiving glucose containing solution 2.5 % had simple hyperglycemia with no hypoglycemic patients recorded while the other group with ringer lactate 2% of patients had simple hyperglycemia and 4% of patients had hypoglycemia . Conclusion The usage of glucose containing solution 2.5% remained controversial, in this study we compared glucose 2.5 % in normal saline 0,9 % to ringer lactate and the results didn’t put a final decision to the usage of glucose containing solutions as The results of the study revealed that 12% of patients receiving glucose containing solution 2.5 % had simple hyperglycemia with no hypoglycemic patients recorded while the other group with ringer lactate 2% of patients had simple hyperglycemia and 4% of patients had hypoglycemia.

Maintenance Fluid Therapy

2017 ◽  
Vol 47 (2) ◽  
pp. 383-395 ◽  
Author(s):  
Bernie Hansen ◽  
Alessio Vigani
Keyword(s):  
Fluid Therapy ◽  
Maintenance Fluid ◽  
Maintenance Fluid Therapy

606 AUDIT: IV Fluid Prescribing in Surgical Patients

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
T Shakir ◽  
E Mills ◽  
A Koomson ◽  
M Iqbal
Keyword(s):  
Kidney Injury ◽  
Improve Patient Care ◽  
District General Hospital ◽  
Recent Change ◽  
Surgical Patients ◽  
Maintenance Fluid ◽  
Maintenance Fluid Therapy ◽  
The Mean ◽  
Maintenance Fluids ◽  
Improve Patient

Abstract Aim A recent change to electronic fluid prescribing has enabled us to evaluate our adherence to recommendations. NICE clinical guideline 174 states that patients should receive 25-30ml/kg/day water and 1mmol/kg/day of sodium, potassium, and chloride with regards to maintenance fluid therapy. We retrospectively audited our practice in surgical patients. Method Patients were selected from two surgical inpatient wards in a district general hospital utilising random sampling over a one-month period. Prescribed intravenous fluid (IV) therapy over a 24-hour period was collected; in addition to weight, presence of an acute kidney injury (AKI) and indication for IV replacement (maintenance versus resuscitation). Results 50 patients were identified during the period. All of them were emergency presentations. Maintenance fluids were prescribed for 76% of patients. No patients had an AKI at time of data collection. The mean weight was 75kg. Overall, patients received a mean fluid volume of 2.3L/day. The mean concentration of electrolytes administered over a 24-hour period were: Sodium 297mmol, Potassium 13mmol, Chloride 237mmol. When adjusting for patient weight, this resulted in a net administration of: Sodium +221mmol, Potassium -62mmol, Chloride +162mmol. Conclusions Three quarters of surgical patients were administered maintenance fluids. The electrolyte contents of these fluids were inadequate. Patients received 295% excess Sodium, 216% excess Chloride, and 82% less than the recommended daily requirement of Potassium. We aim to introduce a protocol for maintenance fluid prescribing, in addition to teaching sessions, that would allow for adherence to guidelines and improve patient care.

Hospital-acquired hyponatremia in children: Epidemiology, pathophysiology, and prevention

2010 ◽  
Vol 01 (01) ◽  
pp. 039-044 ◽  
Author(s):  
Kazunari Kaneko
Keyword(s):  
Fluid Therapy ◽  
Routine Practice ◽  
Close Monitoring ◽  
Healthy Children ◽  
Output Measurement ◽  
Maintenance Fluid ◽  
Maintenance Fluid Therapy ◽  
Hypotonic Fluids ◽  
Sick Children ◽  
Hospital Acquired

AbstractRecent observations have revealed that otherwise healthy children with acute illnesses are prone to hyponatremia due to increased arginine vasopressin production by non-osmotic stimuli. Concern has recently been raised about the potential for iatrogenic hyponatremia as a result of maintenance fluid therapy for those children. To minimize the risk of development of hospital-acquired hyponatremia in sick children receiving maintenance fluid therapy, the routine practice of administration of hypotonic fluids (e.g., 0.18% NaCl with 4% glucose: Na 31 mEq/L, Cl 31 mEq/L) should be abandoned. Instead, isotonic solution, such as 0.9% NaCl (Na 154 mEq/L, K 0 mEq/L, Cl 154 mEq/L) or Hartmann's solution (Na 130 mEq/L, K 4 mEq/L, Cl 110 mEq/L) should be administered. In addition, it must be noted that close monitoring of the children with daily weights, frequent vitals, strict intake and output measurement, and daily chemistries, especially during the first 72 h of parenteral fluid therapy is essential.

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