Abstract

VAZ, Sara et al. Fluid administration: Which direction?. Nascer e Crescer [online]. 2018, vol.27, n.4, pp.227-232. ISSN 0872-0754.  https://doi.org/10.25753/BirthGrowthMJ.v27.i4.13698.

Introduction: Although fluid administration for intravenous hydration is a common practice in pediatric age, it is not devoid of risks. Methods: This was a retrospective cohort study including all children admitted to surgical recovery and receiving intravenous hydration at a Pediatric Intensive Care Unit between January and December 2015. Sodium, chloride, and base excess values were registered on two occasions: after surgery and during Unit’s hospitalization. Results: Two hundred and seven children were included in the study, 66% of which, male, with a median age of 6.7 years. Fluids used consisted of 0.9% saline solution, 0.45% saline solution, and polyelectrolyte solution. The most frequently used fluids were polyelectrolyte (62%) and 0.9% saline solution (48%) at the operating room, and 0.9% saline (63%) and 0.45% saline (44%) solutions at the Pediatric Intensive Care Unit. At the operating room, 0.9% saline solution led to higher chloride median values and more negative base excess (metabolic acidosis) values compared with polyelectrolyte solution. At the Pediatric Intensive Care Unit, 0.9% saline solution administration resulted in hyperchloremia (p=0.002) and more metabolic acidosis (p=0.019) compared with 0.45% saline solution. There was no statistically significant association between type of solution used and sodium values. Discussion: This study shows that the use of 0.9% saline solution is associated with development of hyperchloremic acidosis. This suggests that replacement of 0.9% saline solution with a plasma-like electrolyte solution may improve patient outcomes.

Keywords : Acid-base imbalance; Fluids; Hyperchloremia; Hyponatremia; Metabolic acidosis; Water-electrolyte imbalance.

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