Intravenous fluid management for the acutely ill child

Current Opinion in Pediatrics

Volumn 23, Issue 2, 2011, Pages 186-193

  Moritz, Michael L ^a   Ayus, Juan C ^b  

^a CHILDREN S HOSPITAL OF PITTSBURGH   (United States)

^b Renal Consultants of Houston   (United States)

Author keywords

dehydration; fluid therapy; hypernatremia; hyponatremia; saline; sodium

Indexed keywords

ARGIPRESSIN; HYPOTONIC SOLUTION; INFUSION FLUID; SODIUM; SODIUM CHLORIDE;

CENTRAL NERVOUS SYSTEM DISEASE; CHILD CARE; CRITICALLY ILL PATIENT; EDEMA; FLUID THERAPY; HOSPITAL ACQUIRED HYPONATREMIA; HUMAN; HYPERNATREMIA; HYPONATREMIA; HYPOVOLEMIA; INCIDENCE; NAUSEA; OLIGURIA; PAIN; PEDIATRICS; POSTOPERATIVE PERIOD; PRIORITY JOURNAL; REVIEW; SODIUM RESTRICTION; STRESS; TREATMENT INDICATION; VOMITING; WATER LOSS;

CHILD; CRITICAL CARE; FLUID THERAPY; HUMANS; HYPERNATREMIA; HYPONATREMIA; HYPOTONIC SOLUTIONS; HYPOVOLEMIA; INFUSIONS, INTRAVENOUS; RISK FACTORS; SODIUM CHLORIDE;

EID: 79954419541     PISSN: 10408703     EISSN: None     Source Type: Journal    
DOI: 10.1097/MOP.0b013e3283440fd9     Document Type: Review

References (62)

1. Hasegawa H, Okubo S, Ikezumi Y, et al. Hyponatremia due to an excess of arginine vasopressin is common in children with febrile disease. Pediatr Nephrol 2009; 24:507-511. This article describes how hyponatremia is a common condition affecting the acutely ill child and that elevated AVP levels are common.
2. Don M, Valerio G, Korppi M, Canciani M. Hyponatremia in pediatric community-acquired pneumonia. Pediatr Nephrol 2008; 23:2247-2253.
3. Hoorn EJ, Geary D, Robb M, et al. Acute hyponatremia related to intravenous fluid administration in hospitalized children: an observational study. Pediatrics 2004; 113:1279-1284. (Pubitemid 38580693)
4. Eulmesekian PG, Perez A, Minces PG, Bohn D. Hospital-acquired hyponatremia in postoperative pediatric patients: prospective observational study. Pediatr Crit Care Med 2010; 11:479-483. This article demonstrates the high incidence of hospital-acquired hyponatremia in postoperative children receiving hypotonic fluids.
5. Hanna M, Saberi MS. Incidence of hyponatremia in children with gastroenteritis treated with hypotonic intravenous fluids. Pediatr Nephrol 2010; 25:1471-1475. This article demonstrates that hospital-acquired hyponatremia is common in children with gastroenteritis receiving hypotonic fluids following bolus therapy with normal saline.
6. Singhi S, Jayashre M. Free water excess is not the main cause for hyponatremia in critically ill children receiving conventional maintenance fluids. Indian Pediatr 2009; 46:577-583. This article demonstrates the high incidence of hospital-acquired hyponatremia associated with hypotonic fluids in children admitted to the ICU.
7. Armon K, Riordan A, Playfor S, et al. Hyponatraemia and hypokalaemia during intravenous fluid administration. Arch Dis Child 2008; 93:285-287. (Pubitemid 352025823)
8. Moritz ML, Ayus JC. Preventing neurological complications from dysnatremias in children. Pediatr Nephrol 2005; 20:1687-1700. (Pubitemid 41722951)
9. Moritz ML, Ayus JC. New aspects in the pathogenesis, prevention, and treatment of hyponatremic encephalopathy in children. Pediatr Nephrol 2010; 25:1225-1238. This article reviews the recent reports of hospital-acquired hyponatremic encephalopathy in children related to hypotonic fluids and all the relevant literature demonstrating the high association of hypotonic fluids and hospital-acquired hyponatremia.
10. Moritz ML, Ayus JC. Prevention of hospital-acquired hyponatremia: a case for using isotonic saline. Pediatrics 2003; 111:227-230. (Pubitemid 36177136)
11. Moritz ML, Ayus JC. Hospital-acquired hyponatremia: why are there still deaths? Pediatrics 2004; 113:1395-1396.
12. Moritz ML, Ayus JC. Hypotonic fluids should not be used in volume-depleted children. Kidney Int 2005; 68:409-410. (Pubitemid 43181404)
13. Moritz ML, Ayus JC. Hospital-acquired hyponatremia: why are hypotonic parenteral fluids still being used? Nat Clin Pract Nephrol 2007; 3:374-382.
14. Agency NPS. Patient safety alert 22: reducing the risk of hyponatraemia when administering intravenous infusions to children. London (UK): National Patient Safety Agency; 2007. Available from: http://www.nrls.npsa.nhs.uk/ EasySite-Web/getresource.axd?AssetID=60073&type=full&servicetype= Attachment [accessed 24 September 2009]
15. Hospital-acquired acute hyponatremia: two reports of pediatric deaths. Inst Safe Medication Pract Can Saf Bulletin 2009; 9:1-4. Available from: http://www.ismp-canada.org/download/safetyBulletins/ISMPCSB2009-7- HospitalAcquiredAcuteHyponatremia.pdf [accessed 27 October 2009]
16. Plain D5W or hypotonic saline solutions postop could result in acute hyponatremia and death in healthy children. ISMP Med Saf Alert 2009; 14:1-4. Available from: http://www.ismp.org/Newsletters/acutecare/articles/20090813.asp [accessed 15 September 2009]
17. Koczmara C, Wade AW, Skippen P, et al. Hospital-acquired acute hyponatremia and reports of pediatric deaths. Dynamics 2010; 21:21-26. This article reports on four recent deaths due to hospital-acquired hyponatremic encephalopathy in children receiving hypotonic fluids reported to the Institute of Safe Medication Practices (ISMP) of Canada and the USA. These episodes resulted in each respective agency issuing a warning about the dangers of using hypotonic fluids in children.
18. Wald R, Jaber BL, Price LL, et al. Impact of hospital-associated hyponatremia on selected outcomes. Arch Intern Med 2010; 170:294-302. This report demonstrates that the adjusted odds ratio of in-hospital mortality in adults increases with hospital-associated fall in serum sodium below 138 mEq/l.
19. Renneboog B, Musch W, Vandemergel X, et al. Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits. Am J Med 2006; 119:71.e71-71.e78.
20. Ayus JC, Moritz ML. Bone disease as a new complication of hyponatremia: moving beyond brain injury. Clin J Am Soc Nephrol 2010; 5:167-168.
21. Verbalis JG, Barsony J, Sugimura Y, et al. Hyponatremia-induced osteoporosis. J Bone Miner Res 2010; 25:554-563. These authors are the first to show in animals and humans that mild asymptomatic hyponatremia can produce osteoporosis.
22. Kinsella S, Moran S, Sullivan MO, et al. Hyponatremia independent of osteoporosis is associated with fracture occurrence. Clin J Am Soc Nephrol 2010; 5:275-280. This article demonstrates that mild hyponatremia in the elderly is associated with both hip fractures and osteoporosis.
23. Sajadieh A, Binici Z, Mouridsen MR, et al. Mild hyponatremia carries a poor prognosis in community subjects. Am J Med 2009; 122:679-686.
24. Whelan B, Bennett K, O'Riordan D, Silke B. Serum sodium as a risk factor for in-hospital mortality in acute unselected general medical patients. QJM 2009; 102:175-182.
25. Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997; 336:243-250. (Pubitemid 27044625)
26. Gheorghiade M, Abraham WT, Albert NM, et al. Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry. Eur Heart J 2007; 28:980-988. (Pubitemid 47343897)
27. Kim WR, Biggins SW, Kremers WK, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med 2008; 359:1018-1026.
28. Shea AM, Hammill BG, Curtis LH, et al. Medical costs of abnormal serum sodium levels. J Am Soc Nephrol 2008; 19:764-770.
29. Baraton L, Ancel PY, Flamant C, et al. Impact of changes in serum sodium levels on 2-year neurologic outcomes for very preterm neonates. Pediatrics 2009; 124:e655-661. This is the first prospective study to demonstrate that hyponatremia in the preterm neonate is associated with poor neurological outcome, even after controlling for known risk factors.
30. Moritz ML, Ayus JC. Hyponatremia in preterm neonates: not a benign condition. Pediatrics 2009; 124:e1014-e1016.
31. Wallace WM. Quantitative requirements of the infant and child for water and electrolyte under varying conditions. Am J Clin Pathol 1953; 23:1133-1141.
32. Holliday MA, Segar WE. The maintenance need for water in parenteral fluid therapy. Pediatrics 1957; 19:823-832.
33. Talbot NB, Crawford DJ, Butler AM. Medical progress; homeostatic limits to safe parenteral fluid therapy. N Engl J Med 1953; 248:1100-1108.
34. Weil WB Jr. A unified guide to parenteral fluid therapy. I. Maintenance requirements and repair of dehydration. J Pediatr 1969; 75:1-12.
35. Au AK, Ray PE, McBryde KD, et al. Incidence of postoperative hyponatremia and complications in critically-ill children treated with hypotonic and normotonic solutions. J Pediatr 2008; 152:33-38. (Pubitemid 350265941)
36. Kanda K, Nozu K, Kaito H, et al. The relationship between arginine vasopressin levels and hyponatremia following a percutaneous renal biopsy in children receiving hypotonic or isotonic intravenous fluids. Pediatr Nephrol 2011; 26:99-104. This report demonstrates that even a minimally invasive procedure, a percutaneous renal biopsy, is associated with high AVP levels resulting in hyponatremia and that 0.9% sodium chloride can effectively prevent hyponatremia even in the presence of elevated AVP levels.
37. Kannan L, Lodha R, Vivekanandhan S, et al. Intravenous fluid regimen and hyponatraemia among children: a randomized controlled trial. Pediatr Nephrol 2010; 25:2303-2309. This is the first large prospective randomized fluid trial conducted in general pediatric patients who are nonsurgical and not admitted to the ICU. It demonstrates that hypotonic fluids result in hyponatremia and that 0.9% sodium chloride prevents the development of hyponatremia.
38. Montañana PA, Modesto i Alapont V, Ocon AP, et al. The use of isotonic fluid as maintenance therapy prevents iatrogenic hyponatremia in pediatrics: a randomized, controlled open study. Pediatr Crit Care Med 2008; 9:589-597.
39. Neville KA, Sandeman DJ, Rubinstein A, et al. Prevention of hyponatremia during maintenance intravenous fluid administration: a prospective randomized study of fluid type versus fluid rate. J Pediatr 2010; 156:313-319. This is a carefully designed large prospective trial comparing 0.45% sodium chloride with 0.9% sodium chloride and the development of postoperative hyponatremia. It demonstrates that 0.9% sodium chloride reduces the incidence of hyponatremia and that fluid restriction is of no benefit.
40. Yung M, Keeley S. Randomised controlled trial of intravenous maintenance fluids. J Paediatr Child Health 2009; 45:9-14. This is the first prospective trial specifically evaluating the fall in serum associated with hypotonic versus isotonic fluids.
41. Coulthard MG, Cheater LS, Long DA. Perioperative fluid therapy in children. Br J Anaesth 2007; 98:146-147.
42. Musch W, Decaux G. Treating the syndrome of inappropriate ADH secretion with isotonic saline. QJM 1998; 91:749-753. (Pubitemid 28508621)
43. Moritz ML, Ayus JC. Improving intravenous fluid therapy in children with gastroenteritis. Pediatr Nephrol 2010; 25:1383-1384.
44. Friedman AL. Pediatric hydration therapy: historical review and a new approach. Kidney Int 2005; 67:380-388. (Pubitemid 40019268)
45. Neville KA, Verge CF, O'Meara MW, Walker JL. High antidiuretic hormone levels and hyponatremia in children with gastroenteritis. Pediatrics 2005; 116:1401-1407. (Pubitemid 46056488)
46. Neville KA, Verge CF, Rosenberg AR, et al. Isotonic is better than hypotonic saline for intravenous rehydration of children with gastroenteritis: a prospective randomised study. Arch Dis Child 2006; 91:226-232. (Pubitemid 43325500)
47. Dhawan A, Narang A, Singhi S. Hyponatraemia and the inappropriate ADH syndrome in pneumonia. Ann Trop Paediatr 1992; 12:455-462. (Pubitemid 23019227)
48. Poddar U, Singhi S, Ganguli NK, Sialy R. Water electrolyte homeostasis in acute bronchiolitis. Indian Pediatr 1995; 32:59-65.
49. Shimura N, Arisaka O. Urinary arginine vasopressin in asthma: consideration of fluid therapy. Acta Paediatr Jpn 1990; 32:197-200. (Pubitemid 20367648)
50. Boemke W, Krebs MO, Djalali K, et al. Renal nerves are not involved in sodium and water retention during mechanical ventilation in awake dogs. Anesthesiology 1998; 89:942-953. (Pubitemid 28463300)
51. Cotton MF, Donald PR, Schoeman JF, et al. Raised intracranial pressure, the syndrome of inappropriate antidiuretic hormone secretion, and arginine vasopressin in tuberculous meningitis. Childs Nerv Syst 1993; 9:10-15; discussion 15-16.
52. Padilla G, Leake JA, Castro R, et al. Vasopressin levels and pediatric head trauma. Pediatrics 1989; 83:700-705. (Pubitemid 19120511)
53. Bartter FC, Schwartz WB. The syndrome of inappropriate secretion of antidiuretic hormone. Am J Med 1967; 42:790-806.
54. Wattad A, Chiang ML, Hill LL. Hyponatremia in hospitalized children. Clin Pediatr (Phila) 1992; 31:153-157.
55. Robertson GL. Regulation of arginine vasopressin in the syndrome of inappropriate antidiuresis. Am J Med 2006; 119:S36-S42.
56. Arieff AI, Ayus JC, Fraser CL. Hyponatraemia and death or permanent brain damage in healthy children. BMJ 1992; 304:1218-1222.
57. Davies P, Hall T, Ali T, Lakhoo K. Intravenous postoperative fluid prescriptions for children: a survey of practice. BMC Surg 2008; 8:10.
58. Snaith R, Peutrell J, Ellis D. An audit of intravenous fluid prescribing and plasma electrolyte monitoring; a comparison with guidelines from the National Patient Safety Agency. Paediatr Anaesth 2008; 18:940-946.
59. Way C, Dhamrait R, Wade A, Walker I. Perioperative fluid therapy in children: a survey of current prescribing practice. Br J Anaesth 2006; 97:371-379. (Pubitemid 44295675)
60. Sumpelmann R, Mader T, Eich C, et al. A novel isotonic-balanced electrolyte solution with 1% glucose for intraoperative fluid therapy in children: results of a prospective multicentre observational postauthorization safety study (PASS). Paediatr Anaesth 2010; 20:977-981.
61. Sutherland SM, Zappitelli M, Alexander SR, et al. Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. Am J Kidney Dis 2010; 55:316-325. This study adds to the emerging literature that fluid overload is independently associated with increased mortality in children with multisystem organ failure.
62. Ake JA, Jelacic S, Ciol MA, et al. Relative nephroprotection during Escherichia coli O157:H7 infections: association with intravenous volume expansion. Pediatrics 2005; 115:e673-e680. (Pubitemid 43852790)