Suitable intravenous fluid for preventing dysnatremia in children with gastroenteritis; a randomized clinicaltrial

Golshekan, Kioomars; Badeli, Hamidreza; Miri, Mahboube; Mirzaie, Maryam; Rad, Afagh Hassanzadeh; Salamat, Fatemeh; Tazeabadi, Sepideh Abdi; Bidar, Nahid; Blouki-Moghaddam, Kobra; Hashemian, Houman

doi:10.15171/jrip.2016.15

Cited by 4 publications

(1 citation statement)

References 22 publications

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“…10 Additionally, a randomized study by Golshekan et al in 2016 did not observe a difference in sodium levels between the isotonic and hypotonic solution groups. 11 Notably, most previous studies have been conducted in the Americas and Europe, and there is a lack of established guidelines for treating acute illness patients with mild dehydration in Thailand. To address the knowledge gap, our study aims to compare the effectiveness and safety of isotonic and hypotonic solutions for mildly dehydrated pediatric patients in Thailand.…”

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confidence: 99%

Comparison of the effect of isotonic and hypotonic saline solutions for children with mild dehydration at Lampang Hospital

Boonyatarp,

Bupphajaroensuk,

Loketkrawee

et al. 2024

J Public Hlth Dev

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Administering the appropriate type and rate of fluids is crucial for pediatric patients. Young patients should be given isotonic solutions, as they are safer than hypotonic solutions for fluid maintenance. However, limited studies exist on the efficacy and complications of isotonic solutions for treating acutely ill pediatric patients with mild dehydration. This study aimed to compare isotonic and hypotonic solutions in such cases. A stratified randomized controlled trial was conducted on patients aged 6 months to 15 years with acute illness and mild dehydration in two disease groups: acute gastroenteritis and other diseases. The trial involved administering intravenous fluids, either isotonic or hypotonic solution, for at least 24 hours. Pre and post-treatment serum sodium levels and treatment complications were assessed and compared between patients who received isotonic and hypotonic solutions. A total of 144 patients were randomly assigned to receive either isotonic solution or hypotonic solution. Of the 144 patients, 72 received isotonic and 72 received hypotonic solutions. The isotonic group comprised 51.4% males with a median age of 27.5 months. On the other hand, the hypotonic group comprised 56.9% males with a median age of 38 months. At baseline, both groups' sodium levels were similar at 136.2±2.5 and 136.8±2.5 mmol/L, respectively. After 24 hours, the isotonic group had a statistically significant increase in sodium levels (138.8±2.2 mmol/L; increased median 2.3) compared to the hypotonic group (138.1±2.0 mmol/L; increased median 1.5). In conclusion, no cases of hypernatremia, drowsiness, or seizures were observed, suggesting isotonic solutions can be safely used in these selected groups of acutely ill pediatric patients with mild dehydration.

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Section: Introductionmentioning

confidence: 99%

Comparison of the effect of isotonic and hypotonic saline solutions for children with mild dehydration at Lampang Hospital

Boonyatarp,

Bupphajaroensuk,

Loketkrawee

et al. 2024

J Public Hlth Dev

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Balanced crystalloid solutions versus 0.9% saline for treating acute diarrhoea and severe dehydration in children

Flórez

Sierra

Pérez‐Gaxiola

2023

Cochrane Database of Systematic Reviews

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Background Although acute diarrhoea is a self‐limiting disease, dehydration may occur in some children. Dehydration is the consequence of an increased loss of water and electrolytes (sodium, chloride, potassium, and bicarbonate) in liquid stools. When these losses are high and not replaced adequately, severe dehydration appears. Severe dehydration is corrected with intravenous solutions. The most frequently used solution for this purpose is 0.9% saline. Balanced solutions (e.g. Ringer's lactate) are alternatives to 0.9% saline and have been associated with fewer days of hospitalization and better biochemical outcomes. Available guidelines provide conflicting recommendations. It is unclear whether 0.9% saline or balanced intravenous fluids are most effective for rehydrating children with severe dehydration due to diarrhoea. Objectives To evaluate the benefits and harms of balanced solutions for the rapid rehydration of children with severe dehydration due to acute diarrhoea, in terms of time in hospital and mortality compared to 0.9% saline. Search methods We used standard, extensive Cochrane search methods. The latest search date was 4 May 2022. Selection criteria We included randomized controlled trials in children with severe dehydration due to acute diarrhoea comparing balanced solutions, such as Ringer's lactate or Plasma‐Lyte with 0.9% saline solution, for rapid rehydration. Data collection and analysis We used standard Cochrane methods. Our primary outcomes were 1. time in hospital and 2. mortality. Our secondary outcomes were 3. need for additional fluids, 4. total amount of fluids received, 5. time to resolution of metabolic acidosis, 6. change in and the final values of biochemical measures (pH, bicarbonate, sodium, chloride, potassium, and creatinine), 7. incidence of acute kidney injury, and 8. adverse events. We used GRADE to assess the certainty of the evidence. Main results Characteristics of the included studies We included five studies with 465 children. Data for meta‐analysis were available from 441 children. Four studies were conducted in low‐ and middle‐income countries and one study in two high‐income countries. Four studies evaluated Ringer's lactate, and one study evaluated Plasma‐Lyte. Two studies reported the time in hospital, and only one study reported mortality as an outcome. Four studies reported final pH and five studies reported bicarbonate levels. Adverse events reported were hyponatremia and hypokalaemia in two studies each. Risk of bias All studies had at least one domain at high or unclear risk of bias. The risk of bias assessment informed the GRADE assessments. Primary outcomes Compared to 0.9% saline, the balanced solutions likely result in a slight reduction of the time in hospital (mean difference (MD) −0.35 days, 95% conf...

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ESPNIC clinical practice guidelines: intravenous maintenance fluid therapy in acute and critically ill children— a systematic review and meta-analysis

et al. 2022

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Purpose: Intravenous maintenance fluid therapy (IV-MFT) prescribing in acute and critically ill children is very variable among pediatric health care professionals. In order to provide up to date IV-MFT guidelines, the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) undertook a systematic review to answer the following five main questions about IV-MFT: (i) the indications for use (ii) the role of isotonic fluid (iii) the role of balanced solutions (iv) IV fluid composition (calcium, magnesium, potassium, glucose and micronutrients) and v) and the optimal amount of fluid.Methods: A multidisciplinary expert group within ESPNIC conducted this systematic review using the Scottish Intercollegiate Guidelines Network (SIGN) grading method. Five databases were searched for studies that answered these questions, in acute and critically children (from 37 weeks gestational age to 18 years), published until November 2020. The quality of evidence and risk of bias were assessed, and meta-analyses were undertaken when appropriate. A series of recommendations was derived and voted on by the expert group to achieve consensus through two voting rounds.Results: 56 papers met the inclusion criteria, and 16 recommendations were produced. Outcome reporting was inconsistent among studies. Recommendations generated were based on a heterogeneous level of evidence, but consensus within the expert group was high. "Strong consensus" was reached for 11/16 (69%) and "consensus" for 5/16 (31%) of the recommendations.

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Suitable intravenous fluid for preventing dysnatremia in children with gastroenteritis; a randomized clinicaltrial

Cited by 4 publications

References 22 publications

Comparison of the effect of isotonic and hypotonic saline solutions for children with mild dehydration at Lampang Hospital

Comparison of the effect of isotonic and hypotonic saline solutions for children with mild dehydration at Lampang Hospital

Balanced crystalloid solutions versus 0.9% saline for treating acute diarrhoea and severe dehydration in children

ESPNIC clinical practice guidelines: intravenous maintenance fluid therapy in acute and critically ill children— a systematic review and meta-analysis

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