Hyponatraemia despite isotonic maintenance fluid therapy : A time series intervention study
Chromek, Milan LU ; Jungner, Asa LU ; Rudolfson, Niclas LU ; Ley, David LU ; Bockenhauer, Detlef and Hagander, Lars LU
(2021)
In Archives of Disease in Childhood
106(5).
p.195-491
- Abstract
Objective: To examine the prevalence of dysnatraemias among children admitted for paediatric surgery before and after a change from hypotonic to isotonic intravenous maintenance fluid therapy. Design: Retrospective consecutive time series intervention study. Setting: Paediatric surgery ward at the Children's Hospital in Lund, during a 7-year period, 2010-2017. Patients: All 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 measures: Primary... (More)
Objective: To examine the prevalence of dysnatraemias among children admitted for paediatric surgery before and after a change from hypotonic to isotonic intravenous maintenance fluid therapy. Design: Retrospective consecutive time series intervention study. Setting: Paediatric surgery ward at the Children's Hospital in Lund, during a 7-year period, 2010-2017. Patients: All 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 measures: Primary outcomes were sodium concentration and occurrence of hyponatraemia (<135 mmol/L) or hypernatraemia (>145 mmol/L). Results: Overall, 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%. Conclusions: Routine 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.
(Less)
- author
- Chromek, Milan
LU
; Jungner, Asa
LU
; Rudolfson, Niclas
LU
; Ley, David
LU
; Bockenhauer, Detlef
and Hagander, Lars
LU
- organization
- publishing date
- 2021-04-21
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- general paediatrics, nephrology, paediatric surgery
- in
- Archives of Disease in Childhood
- volume
- 106
- issue
- 5
- pages
- 5 pages
- publisher
- BMJ Publishing Group
- external identifiers
-
- pmid:33115710
- scopus:85094950238
- ISSN
- 0003-9888
- DOI
- 10.1136/archdischild-2019-318555
- language
- English
- LU publication?
- yes
- id
- dd9e3d46-018b-4e09-ac9e-b222dd843bf9
- date added to LUP
- 2020-11-23 09:56:54
- date last changed
- 2024-09-19 09:40:40
@article{dd9e3d46-018b-4e09-ac9e-b222dd843bf9,
abstract = {{<p>Objective: To examine the prevalence of dysnatraemias among children admitted for paediatric surgery before and after a change from hypotonic to isotonic intravenous maintenance fluid therapy. Design: Retrospective consecutive time series intervention study. Setting: Paediatric surgery ward at the Children's Hospital in Lund, during a 7-year period, 2010-2017. Patients: All 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 measures: Primary outcomes were sodium concentration and occurrence of hyponatraemia (<135 mmol/L) or hypernatraemia (>145 mmol/L). Results: Overall, 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%. Conclusions: Routine 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.</p>}},
author = {{Chromek, Milan and Jungner, Asa and Rudolfson, Niclas and Ley, David and Bockenhauer, Detlef and Hagander, Lars}},
issn = {{0003-9888}},
keywords = {{general paediatrics; nephrology; paediatric surgery}},
language = {{eng}},
month = {{04}},
number = {{5}},
pages = {{195--491}},
publisher = {{BMJ Publishing Group}},
series = {{Archives of Disease in Childhood}},
title = {{Hyponatraemia despite isotonic maintenance fluid therapy : A time series intervention study}},
url = {{http://dx.doi.org/10.1136/archdischild-2019-318555}},
doi = {{10.1136/archdischild-2019-318555}},
volume = {{106}},
year = {{2021}},
}