Use Of Isotonic Fluids Research Articles

Perioperative fluid and electrolyte management in surgical neonates

Neonates with surgical conditions may experience significant electrolyte abnormalities and dehydration of varying degrees. Increased awareness of perioperative hyponatremia and its associated morbidity has led to a shift in Pediatric fluid guidelines favoring the use of isotonic fluids. However, there is a lack of evidence-based guidelines for neonatal perioperative fluid administration, resulting in the extrapolation of fluid management principles from adults and children. This article reviews perioperative neonatal fluid management.

SHORT TERM EFFECT OF INTRAVENOUS FLUID THERAPY IN PAEDIATRIC INTENSIVE CARE UNIT ON SERUM ELECTROLYTES AND RENAL FUNCTION TESTS OF CHILDREN

Background: Studies have shown that using hypotonic fluids may result in hyponatremia and the use of isotonic fluids is associated with lower incidence of electrolyte disturbances. Renal functions usually based on measurements of serum urea and creatinine are dependent on the maintenance of appropriate intravascular volume in order to maintain adequate organ perfusion and functioning. Aims and Objectives: To analyze the short term effect of IV Fluids in PICU on serum electrolytes and renal function tests. Methods: This observational descriptive study was conducted in 125 children admitted PICU from April 2022 to September 2022 receiving IV fluids and kept nil by mouth. The levels of serum sodium, potassium, urea and creatinine done at day1 of admission were compared to the investigations done after 72hrs.The data was categorized based on the type of fluid received by the child. Hypotonic fluids (0.45% DNS, D10) and isotonic fluids (0.9% DNS). Results: Out of 125 children, 61(48.8%) received hypotonic fluids whereas 64(51.2%) received isotonic fluids. The average volume of hypotonic fluid given was 3.2±1.7 ml/kg/hr whereas of isotonic fluid given was 2.7±1.3 ml/kg/hr (p=0.11). Hyponatremia developed in 16 out of 42 baseline normal sodium patients in hypotonic group and 6 out of 46 in isotonic group(p=0.03). Serum creatinine was raised in 6(12%) patients out of 50 baseline normal patients in hypotonic group. Serum urea from baseline normal was raised in 7(21.9%) in hypotonic and in 5(17.9%) in isotonic group (p=0.4). Mortality was significantly higher in hypotonic group (13.1%) compared to isotonic group (3.1%) (p=0.04). Conclusions:For preventing positive fluid balance and also development of hyponatremia, isotonic fluids should be considered as routine maintenance fluids.

Drug-Induced Rhabdomyolysis Secondary To Lenalidomide


 Abstract
 
 Lenalidomide is an immunomodulator imide compound that works through its antitumor, anti-angiogenic, and anti-osteoclastogenic effects. It is increasingly used for a multitude of inflammatory disorders and cancers. Diarrhea, thrombocytopenia, neutropenia, and blood clots are well-established severe side effects of Lenalidomide, but rhabdomyolysis is a rare side effect of the drug. It is difficult to reach this diagnosis because it needs a detailed history of the evolution of symptoms and carefully ruling out other etiologies, especially other drugs. Here we present the case of a 75-year-old female who developed rhabdomyolysis and, subsequently, acute kidney injury after receiving Lenalidomide therapy for multiple myeloma. Discontinuation of the diuretics and the use of isotonic fluids led to a gradual improvement in her condition. Physicians should be aware of this potential rare complication and keep it on the differential when treating patients on Lenalidomide.

Association of Tolerance of Uncertainty With Outcomes in a Quality Improvement Collaborative.

Tolerance of uncertainty may influence how physicians and other providers practice and make clinical decisions. We hypothesized that increased tolerance of uncertainty would be associated with an increased uptake of a quality improvement (QI) intervention. We examined tolerance of uncertainty using the Physicians' Reactions to Uncertainty Scale in the context of a national QI project in the Value in Inpatient Pediatrics network. The QI project aimed to increase exclusive isotonic fluid use and decrease laboratory draws. Exposure to the intervention was measured by using the stepped wedge design with sequential implementation across a diverse group of US hospitals. Multivariable analysis was conducted by using exposure to the intervention and tolerance of uncertainty as independent variables and exclusive isotonic fluid use or laboratory testing as the dependent variable. Of 106 participating hospitals, 97 contributed valid responses, with an overall mean reported tolerance of uncertainty of 3.39 (95% confidence interval: 3.27-3.50), with lower numbers on the 6-point scale indicating greater tolerance of uncertainty. Exposure to the QI intervention was significantly associated with exclusive isotonic fluid use (P <.001). Lower tolerance of uncertainty at baseline was associated with lower baseline isotonic fluid use and greater uptake of the use of isotonic fluids but not reduction in laboratory testing. Contrary to our hypothesis, lower tolerance of uncertainty was associated with greater uptake of the QI intervention for the outcome of isotonic fluids. This initial association warrants further study to evaluate how tolerance of uncertainty plays a role in quality improvement science.

Do we overestimate intravenous fluid therapy needs? Adverse effects related to isotonic solutions during pediatric hospital admissions

IntroductionMaintenance intravenous fluids are frequently used in hospitalised pediatric patients. The aim of the study was to describe the adverse effects of isotonic fluid therapy in hospitalised patients, and its prevalence based on the rate of infusion. Materials and methodsA prospective clinical observational study was designed. We included hospitalised patients between 3 months-old and 15-years-old were included with 0,9% isotonic solutions with 5% glucose within the first 24 h of administration. They were divided into two groups, depending on the quantity of liquid they received (restricted <100% vs 100% maintenance needs). Clinical data and laboratory findings were recorded in two different times (T0 when they were admitted to hospital and T1 within the first 24 h of administration). ResultsThe study included 84 patients, 33 received <100% maintenance needs and 51 patients received around 100%. The main adverse effects notified in the first 24 h of administration were hyperchloremia >110 mEq/L (16.6%) and oedema (19%). Oedema was more frequent in patients with lower age (p < 0,01). The hyperchloremia at 24 h of intravenous fluids was an independent risk factor of developing oedema (OR 1,73 (1,0–3,8), p = 0,06). ConclusionThe use of isotonic fluids is not free from adverse effects, probably related to the rate of infusion and more likely to appear in infants. It`s necessary more studies that review the correct estimation of intravenous fluid needs in hospitalized children.

The Effect of Isotonic and Hypotonic Fluid on Serum Sodium in the Pediatric Patient during Surgery

Introduction: Patients need intravenous fluids during Surgery to maintain adequate intravascular volume, cardiac output, and ultimately tissue Oxygen delivery. Aim of the study: Aim of the study was to evaluate serum sodium after infusion of isotonic fluid containing 131 mEq/L sodium with no glucose versus that after infusion of hypotonic fluids containing 75 mEq/L sodium with 5% dextrose. Methods: This study was conducted on pediatric patients of Bangladesh Shishu Hospital and Institute who underwent hernia operations between January 2021 and September 2021. Data are given as mean+standard deviation. P-value &lt;0.05 was considered to be significant. continuous demographic variables were compared using the unpaired t-test, and the chi-square test was used for categorical variables. Result: There were no adverse events and all 40 patients enrolled in this study completed the procedures. The pre-anesthesia and post-anesthesia induction blood sodium concentration. Pre-anesthesia sodium (mEq/L), Isotonic was 138.7 + 1.4 and Hypotonic was 138.9 + 1.5, the charges from pre-anesthesia to postanesthesia induction was - 0.20 + 1.6. Post-anesthesia sodium (mEq/L), Isotonic was 138.5 + 1.5 and Hypotonic was 137.3 + 1.2, the charges from pre-anesthesia to postanesthesia induction was - 1.60 + 1.8. Conclusion: The administration of hypotonic fluids tends to reduce serum sodium absorption in pediatric cases, indeed when administered for a short period. But the use of isotonic fluids helps to avoid a reduction in serum sodium in pediatric and so may enhance patient safety.

0.45% Versus 0.9% Saline in 5% Dextrose as Maintenance Fluids in Children Admitted With Acute Illness: A Randomized Control Trial.

The safety of giving intravenous (IV) maintenance fluids according to Holliday and Segar's recommendations of 1957 has recently been questioned after reports of complications caused by iatrogenic hyponatremia in children receiving hypotonic fluids. However, the current practice of choice of maintenance IV fluids for hospitalized children varies worldwide. This study was planned to compare 0.45% and 0.9% saline in 5% dextrose at standard maintenance rates in hospitalized children aged 3 months to 12 years. Primary objective was to study change in serum sodium level at 24 hours in children receiving total IV fluid maintenance therapy as 0.45% or 0.9% normal saline in 5% dextrose. Secondary objectives of this study were to estimate change in serum sodium levels from the baseline to 48 or 72 hours, if IV fluids were continued, and to find incidence of hyponatremia and hypernatremia after administering these 2 types of maintenance fluids. This study was an open-label, randomized control trial conducted at the Department of Pediatrics of a tertiary care hospital from July 22, 2019, to October 28, 2019. Two hundred children aged 3 months to 12 years admitted in pediatric emergency and requiring IV maintenance fluid were randomized into 2 groups (group A received 0.45% saline in 5% dextrose, group B received 0.9% normal saline in 5% dextrose) with 100 in each group. Both groups were comparable for baseline characteristics. Fall in mean serum sodium from baseline was more with increasing duration of IV fluids until 24 hours in 0.45% saline group as compared with 0.9% saline group, which was statistically significant (P < 0.001). The incidence of mild and moderate hyponatremia was significantly more in hypotonic group at 12 hours (P < 0.001) and 24 hours (P < 0.001). However, there was no significant difference at 48 hours. The fall in serum sodium values was significant, and there was significant risk of hyponatremia with the use of hypotonic fluids at 12 and 24 hours. Hence, the use of isotonic fluids seems to be more appropriate among the hospitalized children.Trial Registration: CTRI/2019/10/021791.

¿Sobreestimamos las necesidades de líquidos? Complicaciones del uso de sueros isotónicos de mantenimiento en plantas de hospitalización pediátrica

IntroductionMaintenance intravenous fluids are frequently used in hospitalised paediatric patients. The aim of the study was to describe the adverse effects of isotonic fluid therapy in hospitalised patients, and its prevalence based on the rate of infusion. Materials and methodsA prospective clinical observational study was designed. We included hospitalised patients between 3 months-old and 15-years-old were included with 0.9% isotonic solutions with 5% glucose within the first 24h of administration. They were divided into two groups, depending on the quantity of liquid they received (restricted<100% vs. 100% maintenance needs). Clinical data and laboratory findings were recorded in two different times (T0 when they were admitted to hospital and T1 within the first 24h of administration). ResultsThe study included 84 patients, 33 received <100% maintenance needs and 51 patients received around 100%. The main adverse effects notified in the first 24h of administration were hyperchloremia>110mEq/L (16.6%) and oedema (19%). Oedema was more frequent in patients with lower age (p<0.01). The hyperchloremia at 24h of intravenous fluids was an independent risk factor of developing oedema (OR 1.73 [1.0–3.8], p=0.06). ConclusionsThe use of isotonic fluids is not free from adverse effects, probably related to the rate of infusion and more likely to appear in infants. It is necessary more studies that review the correct estimation of intravenous fluid needs in hospitalised children.

From hypotonic maintenance fluid to severe hyponatremia: a case report

BackgroundThe principles for maintenance intravenous fluid prescription in children were developed in the 1950s. These guidelines based on the use of hypotonic solutions have been challenged regularly for they seem to be associated with an increased risk of hospital-acquired hyponatremia.Case presentationWe report the case of a 4-week-old Caucasian child admitted for acute bronchiolitis who received hypotonic maintenance fluids and developed severe hyponatremia (94 mmol/L) with hyponatremic encephalopathy.ConclusionThis clinical situation can serve as a reminder of the latest recommendations from the American Academy of Pediatrics regarding the use of intravenous fluids that promote the use of isotonic fluids in children.

Comparison of isotonic and hypotonic intravenous fluids in term newborns: is it time to quit hypotonic fluids

Objective Hypotonic fluids have been traditionally used in newborns. National Institute for Health and Clinical Excellence-2015 (NICE) fluid therapy guideline recommends the use of isotonic fluids as maintenance fluid therapy in term newborns. However, there is no clear evidence supporting this recommendation. This study aims to compare isotonic (5% dextrose in 0.9% sodium chloride (NaCl)) and hypotonic (5% dextrose in 0.45% NaCl) parenteral fluid therapies in hospitalized term newborns with regard to changes in plasma Na (pNa) and complications related with fluid therapy. Methods This was a retrospective cohort study performed in a tertiary university hospital NICU between January 2016 and April 2018. Term newborns who were initially isonatremic or mildly dysnatremic (pNa <130 or >155 meq/L) and receiving fluid therapy for maintenance or replacement therapy after 48th postnatal hours were eligible for the study. Infants having specific diagnoses requiring extraordinary fluids were excluded. The primary outcome evaluated was the change in mean plasma Na (ΔpNa meq/L/h) at 24 h or at the end of intravenous (i.v.) fluid therapy. Secondary outcomes evaluated were the risk of hyponatremia, hypernatremia, and adverse events attributable to fluid administration. Results Among the 108 included newborns, 57 received hypotonic fluid (5% dextrose solution in 0.45% NaCl) and the remaining received isotonic fluid (5% dextrose solution in 0.9% NaCl) therapy. The hypotonic fluid group showed a greater ΔpNa compared to the isotonic group (0.48 ± 0.28 vs. 0.27 ± 0.21 meq/L/h, p = .001). The risk of experiencing unsafe plasma Na decrease in the hypotonic fluid group (ΔpNa >0.5 meq/L/h) was higher than the isotonic fluid group (odd ratio: 8.46; 95% confidence interval (CI): 2.3–30.06). Six mildly hypernatremic babies between 48 and 72 h of postnatal age showed insufficient Na reduction despite the appropriate amount of fluid. No significant difference was found between the two groups in terms of other outcomes. Conclusion The results of this study suggested that as maintenance or replacement fluid therapy in the newborn, hypotonic fluids, even 5% dextrose in 0.45% NaCl, can lead to unsafe plasma Na decreases in term newborns, while isotonic fluids are safe when started after the first few days of life. Although the results parallel NICE guidelines, before making recommendations regarding the removal of hypotonic fluids entirely from clinical practice in term newborns following the renal adaptation period; larger randomized controlled studies involving a wide range of babies are needed.

Hypovolemic Hyponatremia.

The etiology of hyponatremia is often multifactorial. The most common causes include hypovolemia from gastrointestinal (GI) or other fluid losses, thiazide diuretics, and SIAD [<citeref rid="ref1">1</citeref>]. In this chapter, we will discuss hypovolemic hyponatremia, as well as the clinical parameters that help distinguish between hypovolemic and euvolemic states. These include not only the urine [Na+] concentration but also the fractional uric acid excretion, a parameter that can be employed even when diuretics have been prescribed [<citeref rid="ref2">2</citeref>,<citeref rid="ref3">3</citeref>,<citeref rid="ref4">4</citeref>,<citeref rid="ref5">5</citeref>,<citeref rid="ref6">6</citeref>,<citeref rid="ref7">7</citeref>]. Among the common causes of hypovolemic hyponatremia are GI fluid loss, a range of endocrinopathies [<citeref rid="ref7">7</citeref>], and thiazide-induced hyponatremia, which is best considered as a distinct entity, in particular because recent data suggest that it has a genetic predisposition. Also, the discontinuation of thiazide is a key step in treatment [<citeref rid="ref2">2</citeref>,<citeref rid="ref7">7</citeref>]. The management of hypovolemic hyponatremia starts with confirming its presence and determining the underlying cause. Correction focuses on the appropriate use of isotonic fluid to effect volume repletion while avoiding an overly rapid rise in serum [Na+] concentration.

Hyponatraemia in a Lao paediatric intensive care unit: Prevalence, associations and intravenous fluid use.

Hyponatraemia is a common and potentially deadly complication affecting hospitalised children world-wide. Hypotonic intravenous fluids can be a significant exacerbating factor. Exclusive use of isotonic fluids, coupled with rigorous blood monitoring, has proven effective in reducing hyponatraemia in developed settings. In developing countries, where hyponatraemia is often more common and severe, different factors may contribute to its incidence and detection. We aimed to determine the prevalence and disease associations of hyponatraemia and describe the intravenous maintenance fluid prescribing practices in a Lao paediatric intensive care unit. We conducted a cross-sectional study of 164 children aged 1 month to 15 years admitted to intensive care at a tertiary centre in Lao People's Democratic Republic (PDR) and recorded their serum sodium and clinical data at admission and on two subsequent days. Hyponatraemia was detected in 41% (67/164, confidence interval 34-48%) of children, the majority of which was mild (34%, 56/164) and present at admission (35%, 55/158). Hyponatraemia was more common in malnourished children (odds ratio (OR) 2.3, P = 0.012) and females (OR 1.9, P = 0.045). Hyponatraemia correlated with death or expected death after discharge (OR 2.2, P = 0.015); 88% received maintenance intravenous fluids, with 67% of those receiving a hypotonic solution. Electrolyte testing was only performed in 20% (9/46) of patients outside the study protocol. Hyponatraemia is highly prevalent in critically ill children in Lao PDR, as is the continued use of hypotonic intravenous fluids. With financial and practical barriers to safely detecting and monitoring electrolyte disorders in this setting, this local audit can help promote testing and has already encouraged changes to fluid prescribing.

Study of the serum sodium changes in children between 3 months and 5 years age receiving isotonic maintenance intravenous fluids

Background: Isotonic fluid is now the accepted standard of practice as maintenance intravenous fluids. The use of hypotonic fluids has been associated with electrolyte imbalance which could potentially lead to morbidity and mortality. The aim of this prospective study was to assess whether the use of isotonic fluids causes significant changes in the serum sodium concentration and is associated with any related complications in the age group between 3 months and 5 years. Methods: Serum sodium was measured at 0, 12, 24, and 48 h of commencement of isotonic intravenous fluids. Results were analyzed separately for groups between 3–12 months and 13–60 months. Results: All the children in the study group had sodium levels within normal range before the commencement of intravenous fluids. There was no significant change in the mean sodium levels at 12, 24, and 48 h of commencement of intravenous fluids in the age groups between 3–12 months and 13–60 months. There were no complications noted with the use of isotonic intravenous fluids. Conclusion: Use of isotonic intravenous fluids in the age group between 3 months and 5 years is not associated with significant changes in the serum sodium concentrations or adverse events. Hence, isotonic intravenous fluid can be used safely for maintaining hydration in children.

Isotonic versus hypotonic solutions for maintenance intravenous fluid administration in children.

Maintenance intravenous fluids are frequently used in hospitalised children who cannot maintain adequate hydration through enteral intake. Traditionally used hypotonic fluids have been associated with hyponatraemia and subsequent morbidity and mortality. Use of isotonic fluid has been proposed to reduce complications. To establish and compare the risk of hyponatraemia by systematically reviewing studies where isotonic is compared with hypotonic intravenous fluid for maintenance purposes in children.Secondly, to compare the risk of hypernatraemia, the effect on mean serum sodium concentration and the rate of attributable adverse effects of both fluid types in children. We ran the search on 17 June 2013. We searched the Cochrane Injuries Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE (OvidSP), Embase (OvidSP), and ISI Web of Science. We also searched clinical trials registers and screened reference lists. We updated this search in October 2014 but these results have not yet been incorporated. We included randomised controlled trials that compared isotonic versus hypotonic intravenous fluids for maintenance hydration in children. At least two authors assessed and extracted data for each trial. We presented dichotomous outcomes as risk ratios (RR) with 95% confidence intervals (CIs) and continuous outcomes as mean differences with 95% CIs. Ten studies met the inclusion criteria, with a total of 1106 patients. The majority of the studies were performed in surgical or intensive care populations (or both). There was considerable variation in the composition of intravenous fluid, particularly hypotonic fluid, used in the studies. There was a low risk of bias for most of the included studies. Ten studies provided data for our primary outcome, a total of 449 patients in the analysis received isotonic fluid, while 521 received hypotonic fluid. Those who received isotonic fluid had a substantially lower risk of hyponatraemia (17% versus 34%; RR 0.48; 95% CI 0.38 to 0.60, high quality evidence). It is unclear whether there is an increased risk of hypernatraemia when isotonic fluids are used (4% versus 3%; RR 1.24; 95% CI 0.65 to 2.38, nine studies, 937 participants, low quality evidence), although the absolute number of patients developing hypernatraemia was low. Most studies had safety restrictions included in their methodology, preventing detailed investigation of serious adverse events. Isotonic intravenous maintenance fluids with sodium concentrations similar to that of plasma reduce the risk of hyponatraemia when compared with hypotonic intravenous fluids. These results apply for the first 24 hours of administration in a wide group of primarily surgical paediatric patients with varying severities of illness.

Pathophysiology of Hypertrophic Pyloric Stenosis Revisited: The Use of Isotonic Fluid for Preoperative Infusion Therapy Is Supported

Background: The aim of this study was to elucidate the preoperative clinical and biochemical profile of infants with IHPS to optimize infusion therapy. Patients and Method: We retrospectively analyzed data from 56 infants who were operated for IHPS. Our study includes growth and laboratory data prior to the initiation of therapy. Results: Median duration of propulsive vomiting was 4 d; the median age was 37 d (18 - 108), and the median body weight was 3840 g (2760 -5900). Metabolic alkalosis (MAlk) with a pH of 7.45 ± 0.06 and an stHCO3- of 28.7 ± 4.5 mmol/l was found. In a subgroup of the infants, negative base excess (BE) was observed. The sodium concentration was normal or reduced (mean/median of 137 mmol/l). There was a strong negative correlation between stHCO3- and K+. The carbon dioxide partial pressure tended to increase (5.72 ± 0.84 kPa). Calculations of osmolality revealed a normal osmolarity. Hypoglycemia did not occur. The creatinine clearance according to the Schwartz formula remained at a normal level (85.3 ± 24.3 ml/min/1.73 m2). Discussion: The presented case series is characterized by a short duration of preoperative vomiting. MAlk can be classified as a chloride deficiency syndrome. It is accompanied by normo- or hyponatremic dehydration with normal osmolality. Partial respiratory compensation occurred. A normal creatinine clearance indicated good glomerular renal function. Conclusion: The presented study supports the use of an isotonic infusion fluid with a low glucose concentration for preoperative infusion therapy.

Risk of acute hyponatremia in hospitalized children and youth receiving maintenance intravenous fluids

Hospital-acquired acute hyponatremia is increasingly recognized as a cause of morbidity and mortality in children. It has been attributed primarily to the use of hypotonic intravenous (IV) fluids to maintain fluid and electrolyte requirements. This practice point outlines current understanding of the problem and summarizes recent research dealing with this issue. Detailed recommendations are made for the prescription of IV maintenance fluids in children between one month and 18 years of age. The use of isotonic fluid (D5W.0.9% NaCl) is recommended in most circumstances. Hypotonic IV fluids containing less than 0.45% NaCl should not be used to provide routine IV fluid maintenance requirements.

Hyponatremia in patients with respiratory syncytial virus bronchiolitis

Hyponatremia in patients with respiratory syncytial virus bronchiolitis Hiroaki Kanai,1 Yuko Sato,2 Ko Ichihashi21Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi; 2Department of Pediatrics, Saitama Medical Center, Jichi Medical University, Saitama, JapanAbstract: Children with pulmonary diseases are at risk of developing hyponatremia (serum sodium concentrations &lt;136 mEq/L). The aim of this study was to define the clinical and laboratory characteristics of respiratory syncytial virus (RSV) bronchiolitis in patients with hyponatremia and determine the associated risk factors. Medical data of 105 children (56 boys, 49 girls; mean age &plusmn; standard deviation: 9.1 &plusmn; 8.9 months) with RSV bronchiolitis were retrospectively analyzed. At admission, 35.2% of all patients, 13% of the &lt;12-month-old patients, and 58.8% of the 12&ndash;35-month-old patients had hyponatremia. The results show that the development of hyponatremia in inpatients with RSV bronchiolitis is associated with age (12&ndash;35 months), body temperature, high fever (&ge;38.5&deg;C), duration of fever until hospitalization, and high C-reactive protein level at admission. These results indicate that hyponatremia occurs in patients with RSV bronchiolitis exhibiting severe inflammation assessed by fever severity and C-reactive protein level. The use of isotonic fluids is recommended for parenteral therapy of patients with RSV bronchiolitis with risk of developing hyponatremia.Keywords: respiratory syncytial virus, bronchiolitis, hyponatremia, fever, C-reactive protein

The use of isotonic fluid as maintenance therapy prevents iatrogenic hyponatremia in pediatrics: A randomized, controlled open study*

Hypotonic fluids are widely used in pediatrics. Several articles have reported the risk of iatrogenic hyponatremia secondary to this practice. We primarily intend to determine whether the use of isotonic fluids prevents hyponatremia and, secondly, whether these fluids increase the incidence of adverse events. One hundred twenty-two pediatric patients hospitalized in intensive care unit requiring maintenance fluid therapy were randomized to receive isotonic fluids (isotonic group, NaCl = 140 mEq/L) or hypotonic fluids (hypotonic group, NaCl <100 mEq/L). Electrolyte blood concentration, glycaemia, and blood pressure were measured at 0, 6, and 24 hrs after the beginning of fluid therapy. Plasma creatinine, urine specific gravity, and urine electrolyte concentration were measured at 6 hrs. Standard intention-to-treat analysis and Bayesian analysis were conducted to assess the probability of hyponatremia and hypernatremia in each group. At the time of admission to hospital, no differences in natremia or the percentage of hyponatremia were found between groups. At 24 hrs, the percentage of hyponatremia in the hypotonic group was 20.6% as opposed to 5.1% in the isotonic group (p = 0.02). No differences in the number of adverse events other than hyponatremia were observed between groups. The use of hypotonic fluids increases the risk of hyponatremia when compared with isotonic fluids at 24 hrs following infusion (number needed to harm [confidence interval 95%] = 7[4;25]). In our sample, the use of isotonic fluids did not increase the incidence of adverse events compared with hypotonic fluids.

Comparison of Transurethral Vaporization Using PlasmaKinetic™ Energy and Transurethral Resection of Prostate: 1-Year Follow-Up

A prospective study was conducted to evaluate the efficacy and safety of PlasmaKinetic vaporization of prostate (PKVP) relative to standard transurethral resection of prostate (TURP) in the surgical management of benign prostatic hyperplasia (BPH). Between March of 2001 and February of 2003, 75 patients aged 49 to 80 years (median 66 years) with a complaint of lower urinary-tract symptoms and a mean prostate volume of 50 +/- 6 cc were enrolled in this study. We evaluated the operating time, blood transfusion, postoperative irrigation period, and catheter-removal time. Patients were assessed at baseline and during the follow-up using the International Prostate Symptom Score (IPSS) and maximum urinary flow rate (Q(max)). The mean operation time for PKVP (40.3 +/- 15 minutes) was significantly shorter than that of TURP (55 +/- 11.1 minutes) (P < 0.001). The postoperative irrigation period was significantly shorter in the PKVP group (mean 6 +/- 3 hours) than in the TURP group (mean 20 +/- 8 hours) (P < 0.001). The mean catheter-removal time was significantly later after TURP (68 +/- 21 hours) than after PKVP (35 +/- 9 hours) (P < 0.001). The groups had comparable mean IPSS and Q(max) values at baseline, and both had significant improvement in these parameters after operation. For IPSS, especially at the third month after the operation, PKVP patients showed significantly greater improvement (P < 0.001). There was no difference in Q(max) values between the groups (P > 0.05). Whereas blood transfusion was necessary for two patients in the TURP group, there were no transfusions in the PKVP group. Because of the short operating time, smaller blood loss, shorter period of irrigation and catheterization, use of isotonic fluid, and absence of electrical current, PKVP is safe and advantageous. Although these early results have shown that this technique may be a good alternative among the minimally invasive methods for the surgical management of BPH, further studies with longer-term results are essential.

Evaluation of a hypertonic saline-dextran solution for treatment of dogs with shock induced by gastric dilatation-volvulus

Objective To test the hypothesis that small volumes of hypertonic saline-dextran (HSD) solution can be used to effectively resuscitate dogs in shock induced by gastric dilatation-volvulus (GDV). and, compared with administration of large volumes of lactated Ringer's solution (LRS), can be used to limit the overall volume of fluid needed for resuscitation. Design Prospective, clinical study. Animals 15 dogs with GDV-induced shock. Procedure Initially, HSD solution (5 ml/kg of body weight) or LRS (60 to 90 ml/kg) was administered. All dogs then received a maintenance administration (20 ml/kg/h) of LRS. Cardiorespiratory, blood gas, and serum biochemical analyses were performed over a 4-hour period after initiation of treatment. Results Systolic arterial and central venous pressures and plasma volume increased more rapidly in dogs in the HSD + LRS group. The cumulative dose of fluids administered to dogs in the HSD + LRS group was significantly less than that administered to dogs in the LRS group. Serum sodium and chloride concentrations and osmolality increased significantly in dogs in the HSD + LRS group, but not in dogs in the LRS group. Ventricular arrhythmias were detected in both groups of dogs, but did not appear to be induced by either form of fluid therapy. Clinical Implications Administration of HSD rapidly restored cardiorespiratory function and induced resuscitation equivalent to administration of large volumes of LRS. Use of HSD solutions to treat dogs in GDV-induced shock may be more efficient than use of isotonic fluids. Administration of HSD solution was not associated with noticeable complications.