Prescription pattern and utilization of crystalloid intravenous fluids in inpatient pediatric department in a tertiary care hospital

Abstract

Background: Crystalloid intravenous fluids (IVFs) are the mainstay method to maintain homeostasis when a child is unable to uptake the necessary fluids and electrolytes. Recent literature describes the context-dependent use of IVFs, which should be prescribed, ordered, dosed, and delivered like any other drug as they have adverse effects just like drugs. Aims and Objectives: To study the utilization, identify adverse drug reactions (ADRs), conduct cost minimization analysis, and check the appropriateness of the crystalloid IVFs prescribed in the inpatient pediatric department. Materials and Methods: Data were collected prospectively from 240 children aged 2 months to 18 years requiring maintenance IVFs in the inpatient pediatric department from August 2021 to December 2022. Children with known cardiac or renal disorders and those refusing to give consent or assent were excluded from the study. Demofigureic details, clinical profile, details of IVF, including type, cost, and treatment outcome, were recorded. ADRs reported were also analyzed. Results: In this study, the most common diseases were respiratory illnesses (20.42%), pyrexias (17.50%), central nervous system disorders (17.50%), gastrointestinal disorders (10.83%), and poisoning (10%). The average days of admission were 5.15 days. Dextrose-Normal Saline (DNS) was prescribed 77.57% of the time, Normal Saline (NS) 17.97% of the time, and Ringer’s Lactate (RL) 4.47% of the time. ADRs were encountered in 2.5% of cases. Conclusion: The prescribed pattern was in accordance with the AAP guidelines. DNS was most commonly prescribed, whereas RL was more commonly prescribed in acute gastroenteritis. The cost minimization showed that the crystalloid IVF cost can be lowered by 46.32%.