Electrolyte derangements in critically ill children receiving balanced versus unbalanced crystalloid fluid resuscitation

Background Adult studies have demonstrated potential harm from resuscitation with 0.9% sodium chloride (0.9%NaCl), resulting in increased utilization of balanced crystalloids like lactated ringers (LR). The sodium and potassium content of LR has resulted in theoretical safety concerns, although limi...

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Veröffentlicht in:BMC nephrology Jg. 23; H. 1; S. 388 - 9
Hauptverfasser: Stanski, Natalja L., Gist, Katja M., Pickett, Kaci, Brinton, John T., Sadlowski, Jennifer, Wong, Hector R., Mourani, Peter, Soranno, Danielle E., Kendrick, Jessica, Stenson, Erin K.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: London BioMed Central 06.12.2022
BioMed Central Ltd
Springer Nature B.V
BMC
Schlagworte:
Acidosis
Care and treatment
Child
Chloride
Clinical trials
Comparative analysis
Complications and side effects
Critically ill children
Crystalloid Solutions - therapeutic use
Electrolytes
Fluid therapy
Fluids
Hospitals
Humans
Hyperkalemia
Hyponatremia
Informatics
Intensive care
Intensive care units
Internal Medicine
Kidney diseases
Laboratories
Lactated Ringers
Medicine
Medicine & Public Health
Mortality
Nephrology
Normal distribution
Osmoregulation
Patients
Pediatric intensive care
Pediatric research
Pediatrics
Potassium
Prospective Studies
Research Design
Risk factors
Sodium
Sodium chloride
Solutions (Pharmacy)
Variables
Water-electrolyte balance (Physiology)
United States
Hyperkalemia
Hyponatremia
Lactated Ringers
Sodium chloride
Acidosis
ISSN:1471-2369, 1471-2369
Online-Zugang:Volltext
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Zusammenfassung:Background Adult studies have demonstrated potential harm from resuscitation with 0.9% sodium chloride (0.9%NaCl), resulting in increased utilization of balanced crystalloids like lactated ringers (LR). The sodium and potassium content of LR has resulted in theoretical safety concerns, although limited data exists in pediatrics. We hypothesized that use of LR for resuscitation would not be associated with increased electrolyte derangements compared to 0.9%NaCl. Methods A prospective, observational cohort study of critically ill children who received ≥ 20 ml/kg of fluid resuscitation and were admitted to two pediatric intensive care units from November 2017 to February 2020. Fluid groups included patients who received > 75% of fluids from 0.9%NaCl, > 75% of fluids from LR, and a mixed group. The primary outcome was incidence of electrolyte derangements (sodium, chloride, potassium) and acidosis. Results Among 559 patients, 297 (53%) received predominantly 0.9%NaCl, 74 (13%) received predominantly LR, and 188 (34%) received a mixture. Extreme hyperkalemia (potassium ≥ 6 mmol/L) was more common in 0.9%NaCl group (5.8%) compared to LR group (0%), p 0.05. Extreme acidosis (pH > 7.1) was more common in 0.9%NaCl group (11%) compared to LR group (1.6%), p 0.016. Conclusions LR is associated with fewer electrolyte derangements compared to 0.9%NaCl. Prospective interventional trials are needed to validate these findings.
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ISSN:1471-2369
1471-2369
DOI:10.1186/s12882-022-03009-w