AUTHOR=Fernández-Sarmiento Jaime , Pérez Andrea , Echeverri Maria Alejandra , Jimenez Paola , Joachim Maria Alejandra , Andrés-Jagua  

TITLE=Association Between Hyponatremia and Maintenance Intravenous Solutions in Critically Ill Children: A Retrospective Observational Study

JOURNAL=Frontiers in Pediatrics

VOLUME=9

YEAR=2021

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2021.691721

DOI=10.3389/fped.2021.691721

ISSN=2296-2360

ABSTRACT=<p><bold>Objetive:</bold> We sought to determine the association between maintenance intravenous solutions and the presence of hyponatremia in children in pediatric intensive care (PICU).</p><p><bold>Materials and Methods:</bold> An analytical observational study in children hospitalized in the PICU between January 2015 and December 2018. Patients who received maintenance fluids within the first 48 h after admission and who had at least two serum sodium levels drawn during this time were included.</p><p><bold>Measurements and Main Results:</bold> A total of 1,668 patients were admitted to the PICU during the study period, 503 of whom met the inclusion criteria. The median age was 24 months (IQR 8–96) and 50.9% were female. Altogether, 24.1% of the children developed hyponatremia; it was more frequent in those who received hypotonic solutions (63 vs. 37%; OR 1.41 95% CI 0.92, 2.15 <italic>p</italic> = 0.106), who also had a longer hospital stay (20 vs. 14 days, difference in means 8 days, 95% CI 2.67, 13.3, <italic>p</italic> = 0.001). Children who received loop diuretics and those who were post-operative had a greater risk of developing hyponatremia if they received hypotonic solutions (aOR 2.1 95% CI 1.41, 3.0, <italic>p</italic> = 0.000). Those with balanced isotonic solutions had a lower risk of developing hyponatremia (aOR 0.59 95% CI 0.35, 0.99, <italic>p</italic> = 0.004) and hyperchloremia (aOR 0.51 95% CI 0.34, 0.77, <italic>p</italic> = 0.000), adjusted for disease severity. A greater risk of death was found in the group with severe hyponatremia &lt;130 mEq/L (aOR 9.75 95% CI 1.64–58.15; <italic>p</italic> = 0.01).</p><p><bold>Conclusions:</bold> Hyponatremia associated with the use of hypotonic maintenance solutions occurs in one out of four children in intensive care. The use of these solutions is associated with a longer hospital stay, and the main risk groups are post-operative patients and those who receive loop diuretics. Clinical studies are needed to determine which maintenance solutions have the greatest efficacy and safety in critically ill children.</p>