Parenteral Fluid Therapy Research Articles

The efficacy and safety of isotonic and hypotonic fluids in intravenous maintenance fluid therapy in term newborns: national multicenter observational "neofluid" study.

The objective of this study was to evaluate the efficacy and safety of isotonic and hypotonic intravenous fluids in maintenance fluid therapy for term infants. This was a multi-centre, prospective, observational study conducted in 21 participating centres from December 30, 2020, to June 30, 2023. The study included term newborns requiring parenteral fluid therapy for maintenance (NCT04781361). The fluid treatment was divided into two groups based on the concentration of sodium in the parenteral fluid, designated as hypotonic (NaCl <130 mmol/L) and isotonic (NaCl = 130-154 mmol/L). The primary outcomes were the change in mean plasma sodium (pNa) levels per hour (∆pNa mmol/L/h), the incidence of hyponatremia (pNa <135 mmol/L) and hypernatremia (pNa >145 mmol/L), and the occurrence of clinically significant changes in sodium levels (∆pNa >0.5 mmol/L/h). A total of 420 patients from 21 centers were included. The ∆pNa was negative in the hypotonic fluid group and positive in the isotonic fluid group, with a significant difference between the groups [respectively -0.07 ± 0.03 (95% CI: -0.13 to -0.02); 0.04 ± 0.03 (95%CI: -0.02 to 0.09), p = 0.04]. There was no difference between the groups in terms of the development of hypernatremia or a clinically meaningful pNa increase. The hypotonic fluid group had a higher incidence of hyponatremia and a clinically meaningful sodium decrease compared to the isotonic fluid group [7.9% vs. 1.2% (OR:6.5, p:0.03)] and [12.2% vs.4.2% (OR:2.9, p = 0.03)]. Contrary to current understanding, this large-scale study is the first to demonstrate that the use of hypotonic fluids in maintenance fluid therapy for newborns poses a risk of hyponatremia development, whereas isotonic fluid therapy appears safe.

A Portable Fluid Administration System for Prolonged Intravenous Fluid Administration in Subadult and Adult White Rhinoceroses (Ceratotherium simum).

While translocations of white rhinoceroses have become an important conservation tool, dehydration during long-distance transports has been identified as a welfare concern. Intravenous (iv) fluid administration might therefore be useful to mitigate dehydration; however, special requirements need to be met to make iv fluid administration suitable for large, wild rhinoceroses during transport. Requirements include a portable and robust system that is capable of delivering high flow rates, is easy to set up, and remains patent and operating for long periods of time while allowing the animals to freely stand or lay down in the transport crates. Due to the lack of suitable fluid administration systems, we developed a custom-made system consisting of 8 L drip bags, a three-part, 4.4-m-long, large bore and partially coiled administration set, and a robust, battery-operated infusion pump, which allowed us to successfully administer iv fluids at a maintenance rate of 1-2 mL/kg/h to eight rhinoceroses for 24 h during a mock transport. While iv fluid administration in transported rhinoceroses is time intensive and the large amount of drip bags required during lengthy transports might pose a limitation, the developed system may be useful for the long-distance transport of small groups of rhinoceroses. Furthermore, this system would be of value for injured or sick rhinoceroses, which require parenteral fluid therapy when commercially available infusion pumps cannot provide the large fluid volumes needed.

Management of Pediatric Parenteral Fluids.

Parenteral fluid therapy in children requires careful consideration of patient-specific factors such as weight, hydration status, and concomitant disease states. Recent literature has changed the standard of care for maintenance fluids for children in the past decade and brought to light more questions. Concentrations of electrolytes in fluids and the use of balanced fluids are still controversial. This article will review the use of parenteral fluids in children, including fluid content, maintenance fluid rate, treatment of dehydration, and the basics of parenteral fluid ingredients. All pediatric patients should have a plan for fluid therapy that includes careful consideration of hydration status and individual response to therapy.

Efeitos da nutrição parenteral total associada à glutamina, à fluidoterapia enteral, associada ou não à glutamina, e fluidoterapia sobre o lipidograma de equinos submetidos à inanição após laparotomia

ABSTRACT In order to evaluate the effect of total parenteral nutrition associated with glutamine and enteral fluid therapy, associated or not with glutamine, on the lipidogram of horses subjected to starvation (phase 1) and refeeding (phase 2), 16 adult healthy horses were used, mixed breed, aged between four and fourteen years and average weight of 248.40 ± 2.28kg, divided into four experimental groups, with four animals per group: Group ENTGL: enteral fluid therapy with electrolytes associated with glutamine; Group PARGL: total parenteral nutrition associated with glutamine; Group ENTFL: enteral fluid therapy with electrolytes; and Group PARFL: parenteral fluid therapy. This study was divided into two phases: phase 1 and phase 2. Phase 1 consisted of performing exploratory laparotomy and beginning of starvation, in addition to the administration of treatments, according to the group, while phase 2 consisted of re-feeding the animals. Total cholesterol values remained within the normal range for the species throughout the experimental period, but there was a slight increase during phase 1, followed by a decrease in values in phase 2. Hypertriglyceridemia in the ENFL, ENTGL and PARFL groups during phase 1 occurred because of the negative energy balance. The provision of enteral fluid therapy with electrolytes and an energy source, with or without glutamine, or parenteral fluid therapy were not effective in reversing the effects of negative energy balance. Thus, therapeutic protocols that combine enteral or parenteral fluid therapy for prolonged periods and food deprivation need additional nutritional support to avoid the deleterious effects of negative energy balance.

Effects of total parenteral nutrition associated with glutamine, enteral fluid therapy with or without glutamine, and fluid therapy on the acid base and electrolyte balance of horses starved after exploratory laparotomy

This study aimed to evaluate the effects of the total parenteral nutrition associated with glutamine, enteral fluid therapy with or without glutamine, and fluid therapy on the acid–base and electrolyte balance of horses starved after exploratory laparotomy. Sixteen healthy male and female adult horses of mixed breed, aged between 4 and 14 years, and having a mean body weight of 248.40 ± 2.28 kg and a body score index of 3–4 (scale of 1–5) were divided into four groups with four animals per group. After an adaptation period of 30 days, they were randomly divided into four experimental groups: enteral fluid therapy, enteral fluid therapy associated with glutamine, total parenteral nutrition associated with glutamine, and parenteral fluid therapy. The experiment was further divided into two phases: Phase 1 and Phase 2. In Phase 1, an exploratory laparotomy was performed, treatments were administered to the groups and the horses received no food or water other than those given to their respective groups. In Phase 2, the animals were re-fed. Each phase had a total duration of 144 h. Venous blood samples were collected every 24 h throughout the experimental period for blood gas and electrolyte analyses. The following parameters were evaluated: pH, partial pressure of carbon dioxide, total carbon dioxide, bicarbonate, base shift, anion gap, sodium, potassium, chloride, total calcium and magnesium. Completely randomized designs with a 4 × 7 factorial scheme (groups × harvest time) in Phase 1 and a 4 × 6 factorial scheme (groups × harvest time) in Phase 2 were used with four replications. All values were considered significant when p≤0.05 (95% probability). Blood pH, bicarbonate concentration, and base shift in the PARGL group decreased, indicating metabolic acidosis. Changes in the acid–base and electrolyte balance were more intense in the PARGL group than in the other groups. These results demonstrated the need to monitor blood gas and electrolyte balance in horses with food restriction under nutritional support or prolonged fluid therapy so that such changes are promptly corrected.

Parenteral versus enteral fluid therapy for children hospitalised with bronchiolitis.

Parenteral versus enteral fluid therapy for children hospitalised with bronchiolitis.

Fluid management considerations in extremely preterm infants born at 22-24 weeks of gestation

Emerging data regarding the encouraging outcomes of extremely preterm infants from centers taking active approaches to the care of these infants have prompted dialogue regarding optimal medical management. Among the multitude of decisions providers make in caring for extremely premature infants is the prescribing of parenteral fluids. Surprisingly, there are limited data to guide evidenced-based approaches to fluid and electrolyte management in this population. Immaturity of renal function and skin barriers contribute to the impaired capacity of the preterm infant to maintain salt and water homeostasis. This perspective paper highlights developmental physiological properties of the kidney and skin, which the provider needs to understand to provide parenteral fluid therapy. Additionally, we provide recommendations for initial fluid and electrolyte management of the preterm infant based on novel data as well as the published literature.

Parenteral Fluid Therapy in Children

Parenteral fluids are commonly administered in the hospital setting. For decades, clinicians have used a standardized approach for the prescription of maintenance IV fluids. Such an approach, however, has led to concerns regarding the development of hyponatremia using hypotonic fluids, especially in settings of heightened ADH release such as hypovolemia. Compared to balanced solutions for IV fluid administration, normal saline use has led to separate concerns regarding the development of hyperchloremic metabolic acidosis and acute kidney injury. A number of randomized controlled trials have shown lower rates of hyponatremia using isotonic fluids when compared to hypotonic fluids. Clinical practice guidelines from the United Kingdom and United States have both recommended isotonic IV fluids for the otherwise healthy child in need of maintenance fluid administration, while those with alterations in water or solute balance require more individualized approaches. Large studies in adults have shown lower rates of acute kidney injury with balanced solutions compared to normal saline although similar data in children is lacking. Retrospective pediatric data has not shown a consistent difference between these interventions. Isotonic fluids should be first line therapy for otherwise healthy children in need of maintenance IV fluids. Evidence for the standard use of balanced solutions in children remains more limited, until large randomized trials can be performed.

Parenteral versus enteral fluid therapy for children hospitalised with bronchiolitis

Parenteral versus enteral fluid therapy for children hospitalised with bronchiolitis

50 Years Ago in TheJournal ofPediatrics: A Unified Guide to Parenteral Fluid Therapy. I. Maintenance Requirements and Repair of Dehydration

50 Years Ago in TheJournal ofPediatrics: A Unified Guide to Parenteral Fluid Therapy. I. Maintenance Requirements and Repair of Dehydration

Does the addition of dextrose to parenteral fluid therapy during labor decrease time to delivery or risk of cesarean delivery compared with non-dextrose-containing parenteral fluid therapy?

Memorial University Medical Center FMRP, Savannah, GA The authors declare no conflicts of interest.

Pediatric Principles for Pediatric Surgeons - Part I Parenteral Maintenance Fluid Therapy

Pediatric Principles for Pediatric Surgeons - Part I Parenteral Maintenance Fluid Therapy

Enteral fluid therapy administered in continuous flow by naso-ruminal route using three maintenance electrolyte solutions: effects on physiological biomarkers and the hemogram of bovines

ABSTRACT: The aim of this study was to evaluate the effects of three enteral electrolyte solutions, each with different energy sources, administrated as continuous flow on the physiological parameters and blood count of healthy Holstein heifers. Six Holstein heifers were used in a crossover design. All animals received all three treatments: solution with calcium propionate, 4g of NaCl, 0.5g of KCl, 0.3g of MgCl2, and 10g of calcium propionate diluted in 1000mL of water (measured osmolarity: 299mOsm/L); solution with glycerol, 4g of NaCl, 0.5g of KCl, 0.3g of MgCl2, 1g of calcium acetate, and 10mL of glycerol in 1000mL of water (measured osmolarity: 287mOsm/L); solution with propylene glycol, 4g of NaCl, 0.5g of KCl, 0.3g of MgCl2, 1g of calcium acetate, and 15mL of propylene glycol in 1000mL of water (measured osmolarity: 378mOsm/L). Physical evaluations and blood samples were collected immediately before the initiation of fluid therapy, at 3-hour intervals over the 12-hour period of fluid therapy, and 12 hours after the end of fluid therapy. Animals presented no signs of stress or discomfort. All solutions resulted in a significant decrease in erythrocyte concentration, hemoglobin concentration, and hematocrit, without affecting the leukogram. Enteral fluid therapy administered as continuous flow via the naso-ruminal route was well-tolerated by animals with minimal effects on animal welfare, even when administered for 12 hours. This technique is indicated as an alternative route for parenteral maintenance fluid therapy. Electrolyte solutions proposed here were able to significantly expand blood volume.

Abstract P-195: FEASIBILITY OF “RESTRICTIVE MAINTENANCE FLUID THERAPY STRATEGY (RMFTS)” IN CHILDREN WITH SEVERE DENGUE PRESENTING IN SHOCK – A PROSPECTIVE EXPLORATORY TRIAL

Aims & Objectives: Dengue Fever (DF) is an important tropical infection attributing to mortality in children. Fluid therapy remained as cornerstone in management of Severe Dengue (SD). Current CDC protocol guide initial fluid therapy based on presence of Shock and PCV, while de-escalation is done in staggered manner based on PCV reduction We aimed at studying the feasibility of RMFTS - where after 10 ml/kg crystalloid bolus, maintenance fluid will be immediately reduced to 50 % of Holiday Segar calculated volume and further matched to target FO% < 1% (10 ml/Kg/Day). Methods Children (2months-18years age) with ‘Severe Dengue admitted with Shock – GROUP A’ and ‘Dengue with warning signs (DWS) – GROUP B’ were consecutively enrolled and initiated on RMFTS regimen of fluid therapy after parental consent. PCV, Haemoglobin, BP, HR, RR, Lactate, Ferritin, SGOT, SGPT, eCrCl were measured at baseline and after starting fluid therapy. These measurements were compared between both groups. Results Of 36 children enrolled, 20 were SD with shock and 16 were DWS received fluids in view of vomiting and abdominal symptoms. All these children were treated with RMFTS. Despite longer duration of parenteral fluid therapy in Group-A (3.80 Vs 2.38 days p0.02), quantity of fluid given was comparable (26.35 Vs 23.91 ml/day p0.47) in both groups. Baseline PCV and eCrCl were comparable in both groups. Conclusions RMFTS is feasible to be used in resuscitation of children with SD in shock as in those with DWS. The fall or rise in PCV may not directly help in staggered titration of fluid therapy.

Management of Diarrhoeal Dehydration in Childhood: A Review for Clinicians in Developing Countries.

The survival of a child with severe volume depletion at the emergency department depends on the competency of the first responder to recognize and promptly treat hypovolemic shock. Although the basic principles on fluid and electrolytes therapy have been investigated for decades, the topic remains a challenge, as consensus on clinical management protocol is difficult to reach, and more adverse events are reported from fluid administration than for any other drug. While the old principles proposed by Holliday and Segar, and Finberg have stood the test of time, recent systematic reviews and meta-analyses have highlighted the risk of hyponatraemia, and hyponatraemic encephalopathy in some children treated with hypotonic fluids. In the midst of conflicting literature on fluid and electrolytes therapy, it would appear that isotonic fluids are best suitable for the correction of hypotonic, isonatraemic, and hypernatraemic dehydration. Although oral rehydration therapy is adequate to correct mild to moderate isonatraemic dehydration, parenteral fluid therapy is safer for the child with severe dehydration and those with changes in serum sodium. The article reviews the pathophysiology of water and sodium metabolism and, it uses the clinical case examples to illustrate the bed-side approach to the management of three different types of dehydration using a pre-mixed isotonic fluid solution (with 20 or 40 mmol/L of potassium chloride added depending on the absence or presence of hypokalemia, respectively). When 3% sodium chloride is unavailable to treat hyponatraemic encephalopathy, 0.9% sodium chloride becomes inevitable, albeit, a closer monitoring of serum sodium is required. The importance of a keen and regular clinical and laboratory monitoring of a child being rehydrated is emphasized. The article would be valuable to clinicians in less-developed countries, who must use pre-mixed fluids, and who often cannot get some suitable rehydrating solutions.

PREDISPOSING FACTORS AND OUTCOME OF HYPERNATREMIA IN BREASTFED LATE PRETERM AND TERM NEONATES

Background: Inadequate breastfeeding results in hypernatremia in otherwise healthy neonates. Objective: This study finds out the predisposing factors and clinical outcome of hypernatremia in breastfed late preterm and term neonates. Materials and Methods: A descriptive study was conducted in a tertiary hospital with retrospective data from July 2013 to June 2016. Babies with serum sodium ≥ 150 mEq/L were identified. Breastfed babies with little or no formula feeds, gestational age ≥ 34 weeks, and birth weight ≥ 2000 g were included. Babies with congenital anomalies, sepsis, prior parenteral fluid therapy and renal or endocrine diseases causing fluid and electrolyte disturbances were excluded. Total weight loss > 10% or daily weight loss > 5% from the birth weight were considered as excess weight loss. Results: A total of 201 babies were studied. Hypernatremia was significantly more common in babies of primiparous mothers (p 25% weight loss and had serum sodium ≥ 170 mEq/L. There was no death. Three babies had neurodevelopmental problems on follow‑up. Conclusion: Breastfed babies of primiparous mothers and born in summer are predisposed to hypernatremia. Babies presenting at a later age had severe weight loss, severe hypernatremia, and complications.

Early Total Enteral Feeding in Stable Very Low Birth Weight Infants: A Before and After Study.

Fear of necrotizing enterocolitis (NEC) has perpetuated delayed initiation and slow advancement of enteral feeding in very low birth weight (VLBW) infants with inherent risks of parenteral alimentation. The objective of this study was to assess effect of early total enteral feeding (ETEF) on day of achievement of full enteral feeds, feed intolerance, NEC and sepsis. In total, 208 stable VLBW neonates (28-34 weeks) admitted during 6 month periods of three consecutive years were enrolled. First phase (n = 73) constituted the 'before' phase with standard practice of initial intravenous fluid therapy and slow enteral feeding. The second prospective phase (n = 51) consisted of implementation of ETEF with infants receiving full enteral feeds as per day's fluid requirement since Day 1 of life. The third phase (n = 84) was chosen to assess the sustainability of change in practice. Day of achievement of full feeds was significantly earlier in Phases 2 and 3 compared with Phase 1 (8.97 and 5.47 vs. 14.44 days, respectively, p = 0.0001). Incidence of feed intolerance was comparable between Phases 1 and 2 (22 vs. 14%, p = 0.28), with marked reduction in incidence of NEC (14 vs. 4%, p = 0.028). There was a significant decrease in sepsis, duration of parenteral fluid and antibiotic therapy as well as hospital stay with comparable mortality. In stable preterm VLBW infants, ETEF is safe and has the benefit of optimizing nutrition with decrease in sepsis, NEC and hospital stay.

Vascular leakage in dengue--clinical spectrum and influence of parenteral fluid therapy.

Clinical management of dengue relies on careful monitoring of fluid balance combined with judicious intravenous (IV) fluid therapy. However, in patients with significant vascular leakage, IV fluids may aggravate serosal fluid accumulation and result in respiratory distress. Trained physicians followed suspected dengue cases prospectively at seven hospitals across Asia and Latin America, using a comprehensive case report form that included daily clinical assessment and detailed documentation of parenteral fluid therapy. Applying Cox regression, we evaluated risk factors for the development of shock or respiratory distress with fluid accumulation. Most confirmed dengue patients (1524/1734, 88%) never experienced dengue shock syndrome (DSS). Among those with DSS, 176/210 (84%) had fluid accumulation, and in the majority (83%), this was detectable clinically. Among all cases with clinically detectable fluid accumulation, 179/447 (40%) were diagnosed with shock or respiratory distress. The risk for respiratory distress with fluid accumulation increased significantly as the infused volume over the preceding 24 h increased (hazard ratio 1.18 per 10 ml/kg increase; P < 0.001). Longer duration of IV therapy, use of a fluid bolus in the preceding 24 h, female gender and poor nutrition also constituted independent risk factors. Shock and respiratory distress are relatively rare manifestations of dengue, but some evidence of fluid accumulation is seen in around 50% of cases. IV fluids play a crucial role in management, but they must be administered with caution. Clinically and/or radiologically detectable fluid accumulations have potential as intermediate severity endpoints for therapeutic intervention trials and/or pathogenesis studies.

Necrotizing mastitis caused by Staphylococcus aureus in goat. Case report

It is reported a case of necrotizing mastitis by Staphylococcus aureus in goat whose signs were right ceiling with alteration on coloration, tenderness, consistency and bloody discharge. Supportive treatment with parenteral fluid therapy and antibiotics were performed prior to surgery to remove the affected hemigland. Additionally, postoperative topical therapy with hydrogen peroxide, tincture of iodine 2% and copper sulfate was conducted at different times. The treatment applied and the emergency care of the animal in this case were effective for improvement of the clinical case and were extremely important to maintaining the animal´s life.

Intravenous fluid therapy for hospitalized and critically ill children: rationale, available drugs and possible side effects.

Human beings are constituted mainly of water. In particular, children's total body water might reach 75-80% of their body weight, compared to 60-70% in adults. It is therefore not surprising, that children, especially hospitalized newborns and infants, are markedly prone to water and electrolyte imbalances. Parenteral fluid therapy is a cornerstone of medical treatment and is thus of exceptional relevance in this patient population. It is crucial to appreciate the fact that intravenous fluids are drugs with very different characteristics, different indications, contraindications and relevant side effects. In the present review, we will summarize the physiology and pathophysiology of water and electrolyte balance, underlining the importance and high prevalence of non-osmotic antidiuretic hormone release in hospitalized and critically ill children. Furthermore, we will discuss the characteristics and potential side effects of available crystalloids for the paediatric population, making a clear distinction between fluids that are hypotonic or isotonic as compared to normal plasma. Finally, we will review the current clinical practice regarding the use of different parenteral fluids in children, outlining both the current consensus on fluids employed for resuscitation and replacement and the ongoing debate concerning parenteral maintenance fluids.