Ensayo clínico aleatorizado sobre la administración de una solución de mantenimiento intravenosa hipotónica comparada contra una isotónica en pacientes pediátricos críticos / Hypotonic versus isotonic maintenance fluids in critically ill pediatric patients: a randomized control trial

Introducción. Las soluciones hipotónicas se han vinculado a la producción de hiponatremia iatrogénica. Objetivos. Evaluar las variaciones en el sodio sérico (NaS) tras la administración de una solución de mantenimiento intravenosa isotónica (NaCl al 0,9% en dextrosa al 5%) en comparación con una solución de mantenimiento hipotónica (NaCl al 0,45% en dextrosa al 5%). Material y métodos. Ensayo clínico aleatorizado, doble ciego y controlado. Se enrolaron pacientes pediátricos con una estadía esperada en la unidad de cuidados intensivos mayor de 24 horas, NaS normal y líquidos intravenosos > 80% de los líquidos totales de mantenimiento. La concentración sérica de Na se midió antes de colocar la solución de mantenimiento y al reducir la administración de ésta a < 80% del total del aporte. Resultados. Se incorporaron 63 pacientes, que fueron asignados en forma aleatoria a recibir una solución de mantenimiento hipotónica (n= 32) o isotónica (n= 31). Las características basales fueron similares en ambos grupos. No hubo diferencias con respecto a la cantidad de solución administrada (grupo hipotónico 865 ± 853 ml; grupo isotónico 778 ± 649 ml, p= 0,654) o el tiempo de infusión (grupo hipotónico: 24 ± 10,8 horas; grupo isotónico: 27,6 ± 12,8 horas, p= 0,231). Se encontró una diferencia en el NaS luego de la administración de las soluciones de mantenimiento (grupo hipotónico: 137,8 ± 4,3 mmol/L; grupo isotónico: 140,0 ± 4,1 mmol/L, p=0,04). Ninguna de las dos soluciones de mantenimiento aumentó el riesgo de hiponatremia (Na < 135 mmol/L) o de hipernatremia (Na > 145 mmol/L). Conclusiones. Ambas soluciones de mantenimiento, en 24 horas de infusión, no aumentaron el riesgo de producir hiponatremia iatrogénica.

Introduction: Hypotonic fluids have been associated with the development of iatrogenic hyponatremia. Objectives. To assess variations in serum sodium (sNa) following the intravenous administration of isotonic maintenance fluids (0.9% NaCl/5% dextrose) compared to hypotonic maintenance fluids (0.45% NaCl/5% dextrose). Material and Methods. Randomized, controlled, double-blind clinical trial. Pediatric patients with an expected length of stay in the intensive care unit of more than 24 hours were enrolled, with normal serum Na, and IV fluids >80% of total maintenance fluids. Serum Na level was measured before administering maintenance fluids and when reducing the administration to <80% of total fluids. Results. The study included 63 patients who were randomly assigned to receive hypotonic (n= 32) or isotonic (n= 31) maintenance fluids. Baseline characteristics were similar inboth groups. There were no differences in terms of volume of fluid administered (hypotonic group: 865 ± 853 mL; isotonic group: 778 ± 649 mL; p=0.654) or infusion duration (hypotonic group: 24 ± 10.8 hours; isotonic group: 27.6 ± 12.8 hours; p= 0.231). A difference was found in the serum Na following the administration of maintenance fluids (hypotonic group: 137.8 ± 4.3 mmol/L; isotonic group: 140.0 ±4.1 mmol/L, p= 0.04). None of these two maintenance fluids increased the risk of hyponatremia (Na <135 mmol/L) or hypernatremia (Na >145 mmol/L). Conclusions. Neither hypotonic nor isotonic maintenance fluids increased the risk of developing iatrogenic hyponatremia with the 24 hour infusion.

Hypotonic versus isotonic maintenance fluids in critically ill pediatric patients: a randomized controlled trial.

INTRODUCTION: Hypotonic fluids have been associated with the development of iatrogenic hyponatremia. OBJECTIVES: To assess variations in serum sodium (sNa) following the intravenous administration of isotonic maintenance fluids (0.9% NaCl/5% dextrose) compared to hypotonic maintenance fluids (0.45% NaCl/5% dextrose). MATERIAL AND METHODS: Randomized, controlled, double-blind clinical trial. Pediatric patients with an expected length of stay in the intensive care unit of more than 24 hours were enrolled, with normal serum Na, and IV fluids >80% of total maintenance fluids. Serum Na level was measured before administering maintenance fluids and when reducing the administration to <80% of total fluids. RESULTS: The study included 63 patients who were randomly assigned to receive hypotonic (n= 32) or isotonic (n= 31) maintenance fluids. Baseline characteristics were similar in both groups. There were no differences in terms of volume of fluid administered (hypotonic group: 865 ± 853 mL; isotonic group: 778 ± 649 mL; p= 0.654) or infusion duration (hypotonic group: 24 ± 10.8 hours; isotonic group: 27.6 ± 12.8 hours; p= 0.231). A difference was found in the serum Na following the administration of maintenance fluids (hypotonic group: 137.8 ± 4.3 mmol/L; isotonic group: 140.0 ± 4.1 mmol/L, p= 0.04). None of these two maintenance fluids increased the risk of hyponatremia (Na 145 mmol/L). CONCLUSIONS: Neither hypotonic nor isotonic maintenance fluids increased the risk of developing iatrogenic hyponatremia with the 24 hour infusion.

Ensayo clínico aleatorizado sobre la administración de una solución de mantenimiento intravenosa hipotónica comparada contra una isotónica en pacientes pediátricos críticos: a randomized control trial / Hypotonic versus isotonic maintenance fuids in critically ill pediatric patients

Introducción. Las soluciones hipotónicas se han vinculado a la producción de hiponatremia iatrogénica. Objetivos. Evaluar las variaciones en el sodio sérico (NaS) tras la administración de una solución de mantenimiento intravenosa isotónica (NaCl al 0,9% en dextrosa al 5%) en comparación con una solución de mantenimiento hipotónica (NaCl al 0,45% en dextrosa al 5%). Material y métodos. Ensayo clínico aleatorizado, doble ciego y controlado. Se enrolaron pacientes pediátricos con una estadía esperada en la unidad de cuidados intensivos mayor de 24 horas, NaS normal y líquidos intravenosos > 80% de los líquidos totales de mantenimiento. La concentración sérica de Na se midió antes de colocar la solución de mantenimiento y al reducir la administración de ésta a < 80% del total del aporte. Resultados. Se incorporaron 63 pacientes, que fueron asignados en forma aleatoria a recibir una solución de mantenimiento hipotónica (n= 32) o isotónica (n= 31). Las características basales fueron similares en ambos grupos. No hubo diferencias con respecto a la cantidad de solución administrada (grupo hipotónico 865 ± 853 ml; grupo isotónico 778 ± 649 ml, p= 0,654) o el tiempo de infusión (grupo hipotónico: 24 ± 10,8 horas; grupo isotónico: 27,6 ± 12,8 horas, p= 0,231). Se encontró una diferencia en el NaS luego de la administración de las soluciones de mantenimiento (grupo hipotónico: 137,8 ± 4,3 mmol/L; grupo isotónico: 140,0 ± 4,1 mmol/L, p= 0,04). Ninguna de las dos soluciones de mantenimiento aumentó el riesgo de hiponatremia (Na 145 mmol/L). Conclusiones. Ambas soluciones de mantenimiento, en 24 horas de infusión, no aumentaron el riesgo de producir hiponatremia iatrogénica.

Introduction. Hypotonic fluids have been associated with the development of iatrogenic hyponatremia. Objectives. To assess variations in serum sodium (sNa) following the intravenous administration of isotonic maintenance fuids (0.9% NaCl/5% dextrose) compared to hypotonic maintenance fuids (0.45% NaCl/5% dextrose). Material and Methods. Randomized, controlled, double-blind clinical trial. Pediatric patients with an expected length of stay in the intensive care unit of more than 24 hours were enrolled, with normal serum Na, and IV fuids >80% of total maintenance fuids. Serum Na level was measured before administering maintenance fuids and when reducing the administration to <80% of total fuids. Results. The study included 63 patients who were randomly assigned to receive hypotonic (n= 32) or isotonic (n= 31) maintenance fuids. Baseline characteristics were similar in both groups. There were no differences in terms of volume of fuid administered (hypotonic group: 865 ± 853 mL; isotonic group: 778 ± 649 mL; p= 0.654) or infusion duration (hypotonic group: 24 ± 10.8 hours; isotonic group: 27.6 ± 12.8 hours; p= 0.231). A difference was found in the serum Na following the administration of maintenance fuids (hypotonic group: 137.8 ± 4.3 mmol/L; isotonic group: 140.0 ± 4.1 mmol/L, p= 0.04). None of these two maintenance fuids increased the risk of hyponatremia (Na 145 mmol/L). Conclusions. Neither hypotonic nor isotonic maintenance fluids increased the risk of developing iatrogenic hyponatremia with the 24 hour infusion.

Ensayo clínico aleatorizado sobre la administración de una solución de mantenimiento intravenosa hipotónica comparada contra una isotónica en pacientes pediátricos críticos: a randomized control trial / Hypotonic versus isotonic maintenance fuids in critically ill pediatric patients

Introducción. Las soluciones hipotónicas se han vinculado a la producción de hiponatremia iatrogénica. Objetivos. Evaluar las variaciones en el sodio sérico (NaS) tras la administración de una solución de mantenimiento intravenosa isotónica (NaCl al 0,9% en dextrosa al 5%) en comparación con una solución de mantenimiento hipotónica (NaCl al 0,45% en dextrosa al 5%). Material y métodos. Ensayo clínico aleatorizado, doble ciego y controlado. Se enrolaron pacientes pediátricos con una estadía esperada en la unidad de cuidados intensivos mayor de 24 horas, NaS normal y líquidos intravenosos > 80% de los líquidos totales de mantenimiento. La concentración sérica de Na se midió antes de colocar la solución de mantenimiento y al reducir la administración de ésta a < 80% del total del aporte. Resultados. Se incorporaron 63 pacientes, que fueron asignados en forma aleatoria a recibir una solución de mantenimiento hipotónica (n= 32) o isotónica (n= 31). Las características basales fueron similares en ambos grupos. No hubo diferencias con respecto a la cantidad de solución administrada (grupo hipotónico 865 ± 853 ml; grupo isotónico 778 ± 649 ml, p= 0,654) o el tiempo de infusión (grupo hipotónico: 24 ± 10,8 horas; grupo isotónico: 27,6 ± 12,8 horas, p= 0,231). Se encontró una diferencia en el NaS luego de la administración de las soluciones de mantenimiento (grupo hipotónico: 137,8 ± 4,3 mmol/L; grupo isotónico: 140,0 ± 4,1 mmol/L, p= 0,04). Ninguna de las dos soluciones de mantenimiento aumentó el riesgo de hiponatremia (Na 145 mmol/L). Conclusiones. Ambas soluciones de mantenimiento, en 24 horas de infusión, no aumentaron el riesgo de producir hiponatremia iatrogénica.(AU)

Introduction. Hypotonic fluids have been associated with the development of iatrogenic hyponatremia. Objectives. To assess variations in serum sodium (sNa) following the intravenous administration of isotonic maintenance fuids (0.9% NaCl/5% dextrose) compared to hypotonic maintenance fuids (0.45% NaCl/5% dextrose). Material and Methods. Randomized, controlled, double-blind clinical trial. Pediatric patients with an expected length of stay in the intensive care unit of more than 24 hours were enrolled, with normal serum Na, and IV fuids >80% of total maintenance fuids. Serum Na level was measured before administering maintenance fuids and when reducing the administration to <80% of total fuids. Results. The study included 63 patients who were randomly assigned to receive hypotonic (n= 32) or isotonic (n= 31) maintenance fuids. Baseline characteristics were similar in both groups. There were no differences in terms of volume of fuid administered (hypotonic group: 865 ± 853 mL; isotonic group: 778 ± 649 mL; p= 0.654) or infusion duration (hypotonic group: 24 ± 10.8 hours; isotonic group: 27.6 ± 12.8 hours; p= 0.231). A difference was found in the serum Na following the administration of maintenance fuids (hypotonic group: 137.8 ± 4.3 mmol/L; isotonic group: 140.0 ± 4.1 mmol/L, p= 0.04). None of these two maintenance fuids increased the risk of hyponatremia (Na 145 mmol/L). Conclusions. Neither hypotonic nor isotonic maintenance fluids increased the risk of developing iatrogenic hyponatremia with the 24 hour infusion.(AU)

Hypotonic versus isotonic maintenance fluids in critically ill pediatric patients: a randomized controlled trial / Hypotonic versus isotonic maintenance fluids in critically ill pediatric patients: a randomized controlled trial.

INTRODUCTION: Hypotonic fluids have been associated with the development of iatrogenic hyponatremia. OBJECTIVES: To assess variations in serum sodium (sNa) following the intravenous administration of isotonic maintenance fluids (0.9

dextrose) compared to hypotonic maintenance fluids (0.45

dextrose). MATERIAL AND METHODS: Randomized, controlled, double-blind clinical trial. Pediatric patients with an expected length of stay in the intensive care unit of more than 24 hours were enrolled, with normal serum Na, and IV fluids >80

of total maintenance fluids. Serum Na level was measured before administering maintenance fluids and when reducing the administration to <80

of total fluids. RESULTS: The study included 63 patients who were randomly assigned to receive hypotonic (n= 32) or isotonic (n= 31) maintenance fluids. Baseline characteristics were similar in both groups. There were no differences in terms of volume of fluid administered (hypotonic group: 865 ± 853 mL; isotonic group: 778 ± 649 mL; p= 0.654) or infusion duration (hypotonic group: 24 ± 10.8 hours; isotonic group: 27.6 ± 12.8 hours; p= 0.231). A difference was found in the serum Na following the administration of maintenance fluids (hypotonic group: 137.8 ± 4.3 mmol/L; isotonic group: 140.0 ± 4.1 mmol/L, p= 0.04). None of these two maintenance fluids increased the risk of hyponatremia (Na 145 mmol/L). CONCLUSIONS: Neither hypotonic nor isotonic maintenance fluids increased the risk of developing iatrogenic hyponatremia with the 24 hour infusion.

Hypotonic versus isotonic maintenance fluids in critically ill pediatric patients: a randomized controlled trial. / Hypotonic versus isotonic maintenance fluids in critically ill pediatric patients: a randomized controlled trial.

INTRODUCTION: Hypotonic fluids have been associated with the development of iatrogenic hyponatremia. OBJECTIVES: To assess variations in serum sodium (sNa) following the intravenous administration of isotonic maintenance fluids (0.9

NaCl/5

dextrose) compared to hypotonic maintenance fluids (0.45

NaCl/5

dextrose). MATERIAL AND METHODS: Randomized, controlled, double-blind clinical trial. Pediatric patients with an expected length of stay in the intensive care unit of more than 24 hours were enrolled, with normal serum Na, and IV fluids >80

of total maintenance fluids. Serum Na level was measured before administering maintenance fluids and when reducing the administration to <80

of total fluids. RESULTS: The study included 63 patients who were randomly assigned to receive hypotonic (n= 32) or isotonic (n= 31) maintenance fluids. Baseline characteristics were similar in both groups. There were no differences in terms of volume of fluid administered (hypotonic group: 865 ± 853 mL; isotonic group: 778 ± 649 mL; p= 0.654) or infusion duration (hypotonic group: 24 ± 10.8 hours; isotonic group: 27.6 ± 12.8 hours; p= 0.231). A difference was found in the serum Na following the administration of maintenance fluids (hypotonic group: 137.8 ± 4.3 mmol/L; isotonic group: 140.0 ± 4.1 mmol/L, p= 0.04). None of these two maintenance fluids increased the risk of hyponatremia (Na 145 mmol/L). CONCLUSIONS: Neither hypotonic nor isotonic maintenance fluids increased the risk of developing iatrogenic hyponatremia with the 24 hour infusion.