Abstract
Hypotonic solutions have been used in pediatrics for maintenance of intravenous (IV) hydration. However, recent randomized control trials and cohort studies have raised significant concerns for association with hospital-acquired hyponatremia (HAH). The study aimed to assess whether the use of hypotonic parenteral solutions (PS) compared with isotonic PS is associated with increased HAH risk in children with common pediatric conditions. Retrospective chart review of 472 patients aged 2 months to 18 years who received either isotonic or hypotonic PS as maintenance fluids. Administration of hypotonic PS was associated with a four-fold increase in risk of developing HAH in the univariate analysis, (unadjusted odds ratio (OR) = 3.99; 95% confidence interval (CI): 1.36–11.69, p = 0.01). Hypotonic PS were associated with HAH (p = 0.04) when adjusted for the level of admission serum CO2. There was a mean decrease of serum sodium of 0.53 mEq/L in the hypotonic group compared to the mean increase of 4.88 mEq/L in the isotonic group. These data suggest that hypotonic PS are associated with HAH in children admitted for common pediatric conditions. Isotonic PS should be considered as a safer choice for maintenance fluid hydration.
Highlights
Hospital-acquired hyponatremia (HAH) is an electrolyte imbalance affecting as many as 25%to 40% of hospitalized pediatric patients [1]
Several authors have argued that the use of hypotonic versus isotonic maintenance fluids in hospitalized pediatric patients has resulted in high incidence of hospital-acquired hyponatremia (HAH) [6,7,8]
We showed that pediatric patients receiving hypotonic parenteral solutions (PS) had an increased risk of developing HAH compared to patients receiving isotonic PS, without a statistically significant change in their other serum electrolyte levels
Summary
Hospital-acquired hyponatremia (HAH) is an electrolyte imbalance affecting as many as 25%to 40% of hospitalized pediatric patients [1]. Hospital-acquired hyponatremia (HAH) is an electrolyte imbalance affecting as many as 25%. Hyponatremia is common among hospitalized pediatric patients due to the stimulation of antidiuretic hormone (ADH). Volume depletion (vomiting) constitutes a major stimulus for ADH secretion and can result in hyponatremia [2,4]. Hypotonic fluids became the recommended maintenance fluids for pediatric patients after the Holliday and Segar study in 1957 [5]. Several authors have argued that the use of hypotonic versus isotonic maintenance fluids in hospitalized pediatric patients has resulted in high incidence of HAH [6,7,8]. A recent randomized controlled trial (RCT) by McNab et al revealed that isotonic fluids had a significantly decreased risk for hyponatremia compared with hypotonic [9]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
