The effect of NaCl 0.9% and NaCl 0.45% on sodium, chloride, and acid–base balance in a PICU population

Almeida, Helena; Mascarenhas, Maria Inês; Loureiro, Helena; Abadesso, Clara; Nunes, Pedro; Moniz, Marta; Machado, Maria Céu

doi:10.1016/j.jped.2014.12.003

Cited by 17 publications

(17 citation statements)

References 26 publications

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“…There are 6 randomized clinical trials 31,49,50,53,56,59 in which researchers enrolled only ICU patients, and all but one 50 revealed a significant difference favoring isotonic IVFs for the prevention of hyponatremia. Researchers in 8 randomized clinical trials enrolled exclusively patients in a general ward setting, 32,51,52,54,55,57,58,60 and those in all but 2 32, 57 found a significant reduction in hyponatremia among those receiving isotonic IVFs.…”

Section: Varying Acuity (Icu Versus General Ward)mentioning

confidence: 99%

“…Researchers in the majority of studies reviewed in this series did not specifically evaluate the development of acidosis or report on it as a complication. Researchers in 4 studies involving 496 patients evaluated the effect of IVF composition on acid and/or base status, 31,49,54,58 and the majority were not able to demonstrate that 0.9% NaCl resulted in acidosis. Two studies in which researchers compared 0.9% NaCl to 0.45% NaCl involving 357 children found no effect on the development of acidosis based on the change in total carbon dioxide (Tco 2 ), a measure of plasma bicarbonate, with a low Tco 2 being a surrogate marker for acidosis rather than a low pH.…”

Section: Acidosismentioning

confidence: 99%

“…Two studies in which researchers compared 0.9% NaCl to 0.45% NaCl involving 357 children found no effect on the development of acidosis based on the change in total carbon dioxide (Tco 2 ), a measure of plasma bicarbonate, with a low Tco 2 being a surrogate marker for acidosis rather than a low pH. 31,54 Researchers in 1 study compared Hartman solution, which has a base equivalent to 0.45% NaCl, involving 79 patients and found no effect on the development of acidosis based on a change in Tco 2 . 49 Researchers in 1 study involving 60 patients compared 0.9% NaCl to 0.18% NaCl and demonstrated a decrease in pH from 7.36 to 7.32 in the 0.9% NaCl group compared with an increase in pH from 7.36 to 7.38 in the 0.18% NaCl group (P = .01), but the effect on Tco 2 was not reported.…”

Section: Acidosismentioning

confidence: 99%

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Clinical Practice Guideline: Maintenance Intravenous Fluids in Children

et al. 2018

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SUBCOMMITTEE ON FLUID AND ELECTROLYTE THERAPY Maintenance intravenous fluids (IVFs) are used to provide critical supportive care for children who are acutely ill. IVFs are required if sufficient fluids cannot be provided by using enteral administration for reasons such as gastrointestinal illness, respiratory compromise, neurologic impairment, a perioperative state, or being moribund from an acute or chronic illness. Despite the common use of maintenance IVFs, there is high variability in fluid prescribing practices and a lack of guidelines for fluid composition administration and electrolyte monitoring. The administration of hypotonic IVFs has been the standard in pediatrics. Concerns have been raised that this approach results in a high incidence of hyponatremia and that isotonic IVFs could prevent the development of hyponatremia. Our goal in this guideline is to provide an evidence-based approach for choosing the tonicity of maintenance IVFs in most patients from 28 days to 18 years of age who require maintenance IVFs. This guideline applies to children in surgical (postoperative) and medical acute-care settings, including critical care and the general inpatient ward. Patients with neurosurgical disorders, congenital or acquired cardiac disease, hepatic disease, cancer, renal dysfunction, diabetes insipidus, voluminous watery diarrhea, or severe burns; neonates who are younger than 28 days old or in the NICU; and adolescents older than 18 years old are excluded. We specifically address the tonicity of maintenance IVFs in children. The Key Action Statement of the subcommittee is as follows: 1A: The American Academy of Pediatrics recommends that patients 28 days to 18 years of age requiring maintenance IVFs should receive isotonic solutions with appropriate potassium chloride and dextrose because they significantly decrease the risk of developing hyponatremia (evidence quality: A; recommendation strength: strong)

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Section: Varying Acuity (Icu Versus General Ward)mentioning

confidence: 99%

Section: Acidosismentioning

confidence: 99%

Section: Acidosismentioning

confidence: 99%

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Clinical Practice Guideline: Maintenance Intravenous Fluids in Children

et al. 2018

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“…In this guideline, we performed a meta-analysis by synthesizing 18 RCTs (16 RCTs for children over 1 month and two RCTs for newborns) [68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85] and seven SRs [86][87][88]. We sought to examine whether the administration of isotonic fluid compared to hypotonic fluids reduced the incidence of hyponatremia without increasing the risk of hypernatremia during maintenance fluid therapy in pediatric patients including newborns.…”

Section: Remarksmentioning

confidence: 99%

Korean Society of Nephrology 2022 Recommendations on controversial issues in diagnosis and management of hyponatremia

Lee

Yoo

Baek

et al. 2022

Kidney Res Clin Pract

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The Korean Society for Electrolyte and Blood Pressure Research, in collaboration with the Korean Society of Nephrology, has published a clinical practice guideline (CPG) document for hyponatremia treatment. The document is based on an extensive evidence-based review of the diagnosis, evaluation, and treatment of hyponatremia with the multidisciplinary participation of representative experts in hyponatremia with methodologist support for guideline development. This CPG consists of 12 recommendations (two for diagnosis, eight for treatment, and two for special situations) based on eight detailed topics and nine key questions. Each recommendation begins with statements graded by the strength of the recommendations and the quality of the evidence. Each statement is followed by rationale supporting the recommendations. The committee issued conditional recommendations in favor of rapid intermittent bolus administration of hypertonic saline in severe hyponatremia, the use of vasopressin receptor antagonists in heart failure with hypervolemic hyponatremia, and syndrome of inappropriate antidiuresis with moderate to severe hyponatremia, the individualization of desmopressin use, and strong recommendation on the administration of isotonic fluids as maintenance fluid therapy in hospitalized pediatric patients. We hope that this CPG will provide useful recommendations in practice, with the aim of providing clinical support for shared decision-making to improve patient outcomes.

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“…La tabla 3 muestra la osmolaridad de algunas soluciones con dextrosa, tomando en cuenta que la máxima osmolaridad que se tolera por una vía venosa periférica es de 900 mOsm/ L 7 . El objetivo de recomendar soluciones isotónicas es la prevención de la hiponatremia iatrogénica y su consecuencia más severa, la encefalopatía hiponatrémica, entidad claramente asociada con alta morbimortalidad [8][9][10][11][12][13] . El número necesario para tratar con Revisión de literatura Literature review líquidos isotónicos para prevenir la hiponatremia (sodio sérico < 135 mEq/L) es de 7.5 y 27.8 para prevenir la hiponatremia moderada (sodio sérico < 130 mEq/L).…”

Section: Composición De Los Fluidos De Mantenimientounclassified

Fluidoterapia y electrolitos parenterales en pediatría

Campos-Miño

Castro

2020

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La administración de líquidos y electrolitos parenterales es una terapia fundamental de soporte en niños agudamente enfermos si la vía oral no permite la administración de la cantidad o composición requeridas de fluidos, por ejemplo en enfermedades de tipo gastrointestinal, respiratorio, neurológico, o en el período transoperatorio. Al momento de planificar la administración de líquidos y electrolitos parenterales en niños a partir del mes de edad, se debe considerar componentes relacionados con la cantidad de líquidos a infundir considerando los requerimientos secundarios a pérdidas hídricas habituales o requerimientos para reacciones metabólicas, evaluar el grado de deshidratación para la administración de líquidos que complementen el déficit, corregir las pérdidas que se han producido secundarios a una noxa externa (enfermedad, procedimiento quirúrgico, trauma, etc.) y finalmente aportar la cantidad adecuada de fluido que permita re-establecer la perfusión tisular. Es necesario conocer los cambios instaurados basados en la evidencia actual con la finalidad de incorporar a el manejo frecuente de los pacientes considerando también la toxicidad ya sean cualitativos o cuantitativos de esta terapéutica tan necesaria en el manejo del paciente pediátrico.

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The effect of NaCl 0.9% and NaCl 0.45% on sodium, chloride, and acid–base balance in a PICU population

Abstract: The use of saline 0.9% was associated with a lower incidence of electrolyte disturbances.

Cited by 17 publications

References 26 publications

Clinical Practice Guideline: Maintenance Intravenous Fluids in Children

Clinical Practice Guideline: Maintenance Intravenous Fluids in Children

Korean Society of Nephrology 2022 Recommendations on controversial issues in diagnosis and management of hyponatremia

Fluidoterapia y electrolitos parenterales en pediatría

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