Electrolyte derangements in critically ill children receiving balanced versus unbalanced crystalloid fluid resuscitation
Abstract 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, alth...
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| Format: | Article |
| Language: | English |
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BMC
2022-12-01
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| Series: | BMC Nephrology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12882-022-03009-w |
| _version_ | 1811179153107451904 |
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| author | Natalja L. Stanski Katja M. Gist Kaci Pickett John T. Brinton Jennifer Sadlowski Hector R. Wong Peter Mourani Danielle E. Soranno Jessica Kendrick Erin K. Stenson |
| author_facet | Natalja L. Stanski Katja M. Gist Kaci Pickett John T. Brinton Jennifer Sadlowski Hector R. Wong Peter Mourani Danielle E. Soranno Jessica Kendrick Erin K. Stenson |
| author_sort | Natalja L. Stanski |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-04-11T06:31:05Z |
| format | Article |
| id | doaj.art-d6d8354cc46d488c93924f0f06d6f5d4 |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-04-11T06:31:05Z |
| publishDate | 2022-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-d6d8354cc46d488c93924f0f06d6f5d42022-12-22T04:40:05ZengBMCBMC Nephrology1471-23692022-12-012311910.1186/s12882-022-03009-wElectrolyte derangements in critically ill children receiving balanced versus unbalanced crystalloid fluid resuscitationNatalja L. Stanski0Katja M. Gist1Kaci Pickett2John T. Brinton3Jennifer Sadlowski4Hector R. Wong5Peter Mourani6Danielle E. Soranno7Jessica Kendrick8Erin K. Stenson9Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical CenterDepartment of Pediatrics, University of Cincinnati College of MedicineDepartment of Biostatistics and Informatics, University of Colorado Anschutz Medical CampusDepartment of Biostatistics and Informatics, University of Colorado Anschutz Medical CampusResearch Informatics, Children’s Hospital ColoradoDivision of Critical Care Medicine, Cincinnati Children’s Hospital Medical CenterDepartment of Pediatrics, University of Arkansas for Medical Sciences College of MedicineDepartment of Pediatrics, University of Colorado School of MedicineDivision of Renal Disease and Hypertension, University of Colorado Anschutz Medical CampusDepartment of Pediatrics, University of Colorado School of MedicineAbstract 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.https://doi.org/10.1186/s12882-022-03009-wLactated RingersSodium chlorideHyperkalemiaHyponatremiaAcidosis |
| spellingShingle | Natalja L. Stanski Katja M. Gist Kaci Pickett John T. Brinton Jennifer Sadlowski Hector R. Wong Peter Mourani Danielle E. Soranno Jessica Kendrick Erin K. Stenson Electrolyte derangements in critically ill children receiving balanced versus unbalanced crystalloid fluid resuscitation BMC Nephrology Lactated Ringers Sodium chloride Hyperkalemia Hyponatremia Acidosis |
| title | Electrolyte derangements in critically ill children receiving balanced versus unbalanced crystalloid fluid resuscitation |
| title_full | Electrolyte derangements in critically ill children receiving balanced versus unbalanced crystalloid fluid resuscitation |
| title_fullStr | Electrolyte derangements in critically ill children receiving balanced versus unbalanced crystalloid fluid resuscitation |
| title_full_unstemmed | Electrolyte derangements in critically ill children receiving balanced versus unbalanced crystalloid fluid resuscitation |
| title_short | Electrolyte derangements in critically ill children receiving balanced versus unbalanced crystalloid fluid resuscitation |
| title_sort | electrolyte derangements in critically ill children receiving balanced versus unbalanced crystalloid fluid resuscitation |
| topic | Lactated Ringers Sodium chloride Hyperkalemia Hyponatremia Acidosis |
| url | https://doi.org/10.1186/s12882-022-03009-w |
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