Hyponatraemia despite isotonic maintenance fluid therapy: a time series intervention study

• Published in: Archives of disease in childhood Vol. 106; no. 5; pp. 491 - 495
• Main Authors: Chromek, Milan, Jungner, Åsa, Rudolfson, Niclas, Ley, David, Bockenhauer, Detlef, Hagander, Lars
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.05.2021; BMJ Publishing Group
• Subjects: Adolescent; Age groups; Blood levels; Child; Child, Preschool; Children; Chloride; Clinical Medicine; Female; Fluid Therapy - methods; Fluids; general paediatrics; Hospitals; Humans; Hypernatremia - epidemiology; Hypernatremia - etiology; Hypernatremia - therapy; Hyponatremia; Hyponatremia - epidemiology; Hyponatremia - etiology; Hyponatremia - therapy; Hypotonic Solutions - adverse effects; Infant; Intravenous administration; Isotonic Solutions - administration & dosage; Kirurgi; Klinisk medicin; Maintenance; Male; Measurement Techniques; Medical and Health Sciences; Medicin och hälsovetenskap; Neonates; nephrology; Original Research; paediatric surgery; Patients; Pediatrics; Pediatrik; Potassium chloride; Predictor Variables; Prevalence; Regression (Statistics); Retrospective Studies; Sensitivity analysis; Sodium; Sodium - blood; Sodium chloride; Statistical Analysis; Surgery; Time series; nephrology; general paediatrics; paediatric surgery
• ISSN: 0003-9888; 1468-2044; 1468-2044
• DOI: 10.1136/archdischild-2019-318555

ObjectiveTo examine the prevalence of dysnatraemias among children admitted for paediatric surgery before and after a change from hypotonic to isotonic intravenous maintenance fluid therapy.DesignRetrospective consecutive time series intervention study.SettingPaediatric surgery ward at the Children’s Hospital in Lund, during a 7-year period, 2010–2017.PatientsAll children with a blood sodium concentration measurement during the study period were included. Hypotonic maintenance fluid (40 mmol/L NaCl and 20 mmol/L KCl) was used during the first 3 years of the study (646 patients), and isotonic solution (140 mmol/L NaCl and 20 mmol/L KCl) was used during the following period (807 patients).Main outcome measuresPrimary outcomes were sodium concentration and occurrence of hyponatraemia (<135 mmol/L) or hypernatraemia (>145 mmol/L).ResultsOverall, the change from hypotonic to isotonic intravenous maintenance fluid therapy was associated with a decreased prevalence of hyponatraemia from 29% to 22% (adjusted OR 0.65 (0.51–0.82)) without a significantly increased odds for hypernatraemia (from 3.4% to 4.3%, adjusted OR 1.2 (0.71–2.1)). Hyponatraemia <130 mmol/L decreased from 6.2% to 2.6%, and hyponatraemia <125 mmol/L decreased from 2.0% to 0.5%.ConclusionsRoutine use of intravenous isotonic maintenance fluids was associated with lower prevalence of hyponatraemia, although hyponatraemia still occurred in over 20% of patients. We propose that the composition and the volume of administered fluid need to be addressed.