Isotonic Intravenous Maintenance Fluid Reduces Hospital Acquired Hyponatremia in Young Children with Central Nervous System Infections

Pemde, Harish; Dutta, A. K.; Sodani, Ravitanaya; Mishra, Kirtisudha

doi:10.1007/s12098-014-1436-1

Cited by 25 publications

(24 citation statements)

References 15 publications

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“…This age group has been excluded from most of the meta-analyses,14 18 19 the PIMS study16 and the paper by Pemde 17. The paper by Friedman with 110 children is the only study that included children of ≥1 month 15.…”

Section: Age Of the Childmentioning

confidence: 99%

Not enough salt in maintenance fluids!

Powell

2015

Arch Dis Child

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Section: Age Of the Childmentioning

confidence: 99%

Not enough salt in maintenance fluids!

Powell

2015

Arch Dis Child

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“…Additionally, obstructive hydrocephalus and < 3.5 years of age were identified as significant independent risk factors for severe hyponatremia among those affected. The risk for hospital-acquired hyponatremia and hyponatremic encephalopathy have been related to the use of hypotonic intravenous solutions [6,[70][71][72][73][74][75][76][77] . Wang et al [78] found a significantly higher risk for hyponatremia and severe hyponatremia among pediatric patients administered hypotonic solutions compared with isotonic fluids in a systematic review of ten randomized clinical trials involving 855 subjects.…”

Section: Childrenmentioning

confidence: 99%

Impact of perioperative hyponatremia in children: A narrative review

Andersen

Afshari

2014

WJCCM

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For more than 50 years, hypotonic fluids (crystalloids) have been the standard for maintenance fluid used in children. In the last decade, several studies have evaluated the risk of hyponatremia associated with the use of hypotonic vs isotonic fluids, which has lead to an intense debate. Children undergoing surgery have several stimuli for release of antidiuretic hormone, which controls renal water handling, including pain, nausea, vomiting, narcotic use and blood loss. The body's primary defense against the development of hyponatremia is the ability of the kidneys to excrete free water and dilute urine. Increased levels of antidiuretic hormone can result in hyponatremia, defined as a plasma sodium level < 136 mmol/L, which causes cells to draw in excess water and swell. This manifests as central nervous system symptoms such as lethargy, irritability and seizures. The risk for symptomatic hyponatremia is higher in children than in adults. It represents an emergency condition, and early diagnosis, prompt treatment and close monitoring are essential to reduce morbidity and mortality. The widespread use of hypotonic fluids in children undergoing surgery is a matter of concern and more focus on this topic is urgently needed. In this paper, we review the literature and describe the impact of perioperative hyponatremia in children. Key words: Children; Fluid; Hyponatremia; Pediatric; Perioperative Core tip: Hospital-acquired hyponatremia is common, particularly among children undergoing surgery. These children tend to develop hyponatremic encephalopathy at higher serum sodium concentrations than adults and they have a poorer prognosis. As the risk is increased by the use of hypotonic fluids, intraoperative fluids for children should be isotonic. Symptomatic hyponatremia should be corrected with 3% sodium chloride and close monitoring of the patient and serum sodium level is mandatory to prevent brain herniation and neurologic damage from cerebral ischemia.Andersen C, Afshari A. Impact of perioperative hyponatremia in children: A narrative review. World J Crit Care Med 2014; 3(4): 95-101 Available from:

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“…Pulmonary infections are known to be associated with increased risk of hyponatremia [17][18][19][20]. Here, the authors bring forth a study comparing the risk of hyponatremia between hypotonic and isotonic PMS administered to children with very severe pneumonia admitted in the general pediatric ward.…”

Section: Introductionmentioning

confidence: 99%