From hypotonic maintenance fluid to severe hyponatremia: a case report

Michel, Denis; Giacomo, Alessio Di; Lacotte, E.; Porcheret, Florence; Letouzé, N.; Lauzier, Benjamin; Goyer, Isabelle; Brossier, David

doi:10.1186/s13256-021-02889-0

“…When administered intravenously, hyponatremia typically occurs within 3 to 72 hours after administration. [5][6][7][8][9][10][11][12][13] CTXinduced hyponatremia can be caused by either the initial dose or multiple doses.…”

Section: Discussionmentioning

confidence: 99%

“…Chen et al • Medicine (2024) 103: 13 Medicine than 2 weeks. Her left breast had solid nodules measuring approximately 3.0 cm × 2.0 cm × 1.5 cm, which were classified as BI-RADS Class 4C after a breast ultrasound was performed.…”

Section: Guangzhou Health Science and Technology Program(20221a010056)mentioning

confidence: 99%

Severe hyponatremia and diabetes insipidus caused by low-dose cyclophosphamide in breast cancer patients: A case report and literature review

Chen,

Li,

Ou

et al. 2024

Medicine

1

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Rationale: Cyclophosphamide (CTX) is widely used in the treatment of malignancies and autoimmune diseases. Although severe hyponatremia caused by low-dose CTX chemotherapy is uncommon, it can lead to serious complications and even death. Patient concerns: A 44-year-old woman with left-sided breast cancer suddenly experienced headaches, disorientation and weakness after receiving low-dose neoadjuvant chemotherapy combined with CTX and doxorubicin. Diagnoses: The patient pathology showed invasive breast carcinoma. She developed severe hyponatremia and a generalized seizure after completing the first cycle of neoadjuvant chemotherapy with CTX and doxorubicin. Laboratory tests showed a serum sodium of 118 mmol/L (normal range 135–145 mmol/L) and potassium sodium 3.16 mmol/L (normal range 3.5–5.5 mmol/L). Subsequently, the patient developed secondary diabetes insipidus 4 hours after sodium supplementation, her 24-hour urine volume was 4730 mL (normal range 1000–2000 mL/24 hours), and the urine specific gravity decreased to 1.005. Interventions: The patient was given intravenous sodium chloride (500 mL of 3%NaCl, 100 mL/hour) and potassium chloride (500 mL of 0.3%KCl, 250 mL/hour). Meanwhile, she was advised to reduce her water intake, and pituitrin was administered to prevent dehydration caused by diabetes insipidus. Outcomes: The patient completely recovered after correcting of the serum sodium concentration (137 mmol/L) without any neurological deficits. After discontinuing pituitrin, her 24-hour urine volume was 2060 mL and the urine specific gravity was 1.015. Lessons: This is a typical case of severe hyponatremia induced by low-dose CTX. Clinicians and healthcare providers should be aware of this potential toxicity, and appropriate monitoring should be implemented.

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“…Such manipulations give rise to significant patient risks regarding the uncertainty in physico-chemical stability, microbial contamination, prescription and preparation errors while manipulating electrolytes, as well as alterations of the tonicity and/or the balanced nature of the original fluid [7]. Some clinicians have considered using paediatric IV fluids marketed for the peri-operative period as alternatives that are balanced isotonic fluids with 1% glucose.…”

Section: Discussionmentioning

confidence: 99%

How to follow the guidelines, when the appropriate fluid is missing?

Brossier,

Goyer,

Morice

et al. 2024

Preprint

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Intravenous maintenance fluid therapy (IV-MFT) is probably the most prescribed drug in paediatric hospital care. Recently paediatric societies have produced evidence-based practice guidelines that recommend the use of balanced isotonic fluid when prescribing IV-MFT in both acute and critical paediatric care. Unfortunately, the applicability of these guidelines could be called into question when a ready-to-use glucose containing balanced isotonic fluid is not available. The main objective of this study was to describe the availability of glucose containing balanced isotonic fluids in European and Middle Eastern paediatric acute and critical care settings. This work is an ancillary study of the survey dedicated to IV-MFT practices in the paediatric acute and critical care settings in Europe and Middle East, a cross-sectional electronic 27-item survey, emailed in April–May 2021 to paediatric critical care physicians across 34 European and Middle East countries. The survey was developed by an expert multi-professional panel within the European Society of Peadiatric and Neonatal Intensive Care (ESPNIC). Balanced Isotonic Fluid with glucose 5% was available for only 32/153 (21%) responders. Balanced Isotonic Fluid with glucose 5% was consistently available in the United Kingdom (90%) but not available in France, Greece, The Netherlands and Turkey. Ready-to-use isotonic balanced IV solutions containing glucose in sufficient amount exist, but are inconsistently available through Europe. National and European Medication Safety Incentives should guarantee availability of the most appropriate and safest IV-MFT solution for all children.

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How to follow the guidelines, when the appropriate fluid is missing?

Brossier,

Goyer,

Morice

et al. 2024

Eur J Pediatr

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Intravenous maintenance fluid therapy (IV-MFT) is probably the most prescribed drug in paediatric hospital care. Recently paediatric societies have produced evidence-based practice guidelines that recommend the use of balanced isotonic fluid when prescribing IV-MFT in both acute and critical paediatric care. Unfortunately, the applicability of these guidelines could be called into question when a ready-to-use glucose-containing balanced isotonic fluid is not available. The main objective of this study was to describe the availability of glucose-containing balanced isotonic fluids in European and Middle Eastern paediatric acute and critical care settings. This work is an ancillary study of the survey dedicated to IV-MFT practices in the paediatric acute and critical care settings in Europe and Middle East, a cross-sectional electronic 27-item survey, emailed in April–May 2021 to paediatric critical care physicians across 34 European and Middle East countries. The survey was developed by an expert multi-professional panel within the European Society of Peadiatric and Neonatal Intensive Care (ESPNIC). Balanced isotonic fluid with glucose 5% was available for only 32/153 (21%) responders. Balanced isotonic fluid with glucose 5% was consistently available in the UK (90%) but not available in France, Greece, The Netherlands and Turkey. Conclusion: Ready-to-use isotonic balanced IV solutions containing glucose in sufficient amount exist but are inconsistently available throughout Europe. National and European Medication Safety Incentives should guarantee the availability of the most appropriate and safest IV-MFT solution for all children. What is Known:• Intravenous maintenance fluid therapy (IV-MFT) is probably the most prescribed drug in paediatric hospital care.• Balanced isotonic fluid is recommended when prescribing IV-MFT in both acute and critical paediatric care. What is New:• Balanced isotonic fluid with glucose 5% is available for less than 25% of the prescribers in Europe and the Middle East. Availability of balanced isotonic fluid with glucose 5% varies from one country to another but can also be inconsistent within the same country.• Clinicians who have access to a ready-to-use balanced isotonic fluid with glucose 5% are more likely to consider its use than clinicians who do not have access to such an IV solution.

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From hypotonic maintenance fluid to severe hyponatremia: a case report

Cited by 4 publications

References 20 publications

Severe hyponatremia and diabetes insipidus caused by low-dose cyclophosphamide in breast cancer patients: A case report and literature review

Severe hyponatremia and diabetes insipidus caused by low-dose cyclophosphamide in breast cancer patients: A case report and literature review

How to follow the guidelines, when the appropriate fluid is missing?

How to follow the guidelines, when the appropriate fluid is missing?

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