Abstract
To evaluate maintenance intravenous fluid-prescribing practices and the incidence of hospital-acquired hyponatremia in children admitted to a general pediatric ward. This is a prospective observational study conducted over a 2-month period in children ages 2 months to 5 years who were admitted to a general pediatric ward and who were receiving maintenance intravenous fluids. The composition, rate, and duration of intravenous fluids were chosen at the discretion of the treating physician. Serum biochemistries were obtained at baseline and 24 h following admission. Patients who were at high risk for developing hyponatremia or hypernatremia or had underlying chronic diseases or were receiving medications associated with a disorder in sodium and water homeostasis were excluded. Intravenous fluid composition and the incidence of hyponatremia (sodium <135 mEq/L) were assessed. Fifty-six children were enrolled. All received hypotonic fluids; 87.5% received 0.18% sodium chloride (NaCl) and 14.3% received 0.45% NaCl. Forty percent of patients (17/42) with a serum sodium (SNa) less than 140 mEq/L experienced a fall in SNa with 12.5% of all patients (7/56) developing hospital-acquired or aggravated hyponatremia (126-134 mEq/L) with fall in SNa between 2 and 10 mEq/L. Administration of hypotonic fluids was a prevalent practice in children admitted to a general pediatric ward and is associated with acute hospital-acquired hyponatremia.
Highlights
Over the past decade, there has been increasing concern that the routine practice of administrating hypotonic intravenous maintenance fluids to hospitalized children leads to potentially dangerous hyponatremia [1, 2]
The majority of prospective and retrospective studies evaluating the relationship between hypotonic fluids and hospital-acquired hyponatremia have included high-risk patients, such as patients admitted to the intensive care unit [8], post-surgical patients [9, 10], and patients with gastroenteritis [11], and diverse patient populations, including patients with malignancies and cardiac and renal diseases [7, 12, 13]
We suspected that hypotonic fluids are still commonly used and associated with hospital-acquired hyponatremia, despite the significant literature supporting the use of isotonic maintenance fluids
Summary
There has been increasing concern that the routine practice of administrating hypotonic intravenous maintenance fluids to hospitalized children leads to potentially dangerous hyponatremia [1, 2]. A recent large retrospective study demonstrated that the incidence of hospital-acquired hyponatremia in children receiving hypotonic fluids is nearly 40% [7]. The majority of prospective and retrospective studies evaluating the relationship between hypotonic fluids and hospital-acquired hyponatremia have included high-risk patients, such as patients admitted to the intensive care unit [8], post-surgical patients [9, 10], and patients with gastroenteritis [11], and diverse patient populations, including patients with malignancies and cardiac and renal diseases [7, 12, 13]. To the best of our knowledge, there have been no prospective observational studies evaluating maintenance intravenous fluidprescribing practices and the incidence of hospital-acquired hyponatremia in children admitted to a general pediatric ward. We suspected that hypotonic fluids are still commonly used and associated with hospital-acquired hyponatremia, despite the significant literature supporting the use of isotonic maintenance fluids
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