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1.
Med Klin Intensivmed Notfmed ; 115(1): 29-36, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31792559

RESUMO

Hyponatremia (sodium <135 mmol/l) is the most common electrolyte disorder. Despite identical serum concentrations, clinical symptomatology can vary greatly from mild to life-threatening. Accordingly, individual patients require immediate active treatment, while the majority of (mostly oligosymptomatic) patients should first undergo differentiated diagnosis. The most important element is the assessment of the clinical situation of the patient and never isolated laboratory chemical constellations: "Treat the patient, not the numbers".


Assuntos
Cuidados Críticos , Hiponatremia , Fluxo de Trabalho , Humanos , Hiponatremia/diagnóstico , Hiponatremia/terapia , Sódio
2.
Trans Am Clin Climatol Assoc ; 130: 76-87, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31516170

RESUMO

Exercise-associated hyponatremia (EAH) is defined by an acute fall in the serum or plasma sodium concentration to below 135 mmol/L that occurs during or up to 24 hours after prolonged physical activity. EAH has been reported in nearly every form of endurance activity and has a common pathogenic feature of excessive water intake which is usually coupled with elevated vasopressin levels. Symptomatic EAH is uncommon but can be a cause of mortality in otherwise healthy adults and children. Rapid recognition and appropriate treatment with hypertonic saline are essential to maximizing outcomes and preventing death.


Assuntos
Arginina Vasopressina/metabolismo , Comportamento de Ingestão de Líquido , Água Potável , Exercício/fisiologia , Hiponatremia/fisiopatologia , Doenças Assintomáticas , Hidratação , Humanos , Hiponatremia/epidemiologia , Hiponatremia/metabolismo , Hiponatremia/terapia , Solução Salina Hipertônica/uso terapêutico
3.
J Vet Emerg Crit Care (San Antonio) ; 29(5): 461-471, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31448558

RESUMO

OBJECTIVE: To review the pathophysiology, diagnostic approach, and treatment recommendations for hyponatremia in dogs and cats. ETIOLOGY: Hyponatremia almost always results from an increase in total body water (TBW), and not from loss of sodium. Abnormalities in antidiuretic hormone (ADH) are commonly part of the etiology of hyponatremia. DIAGNOSIS: Diagnosis of hyponatremia focuses on the cause of the increase of TBW. Assessment of the patient's volume status and measurement of urine sodium concentration are important factors. Measurement or calculated estimation of plasma osmolality can also guide the assessment of hyponatremia. THERAPY: Too rapid correction of serum sodium can precipitate osmotic demyelination syndrome. As a general rule, serum sodium concentration should be raised ≤10 mmol/L over 24 hours, but rapid increases in serum sodium are indicated if neurologic abnormalities are evident. Serum sodium can be increased using hypertonic saline, with dosing based on the patient's calculated sodium deficit. Treatment of the underlying cause of water ingestion or retention is also required to fully resolve hyponatremia. PROGNOSIS: Mortality rates are significantly higher in dogs and cats with hyponatremia compared to those with normal serum sodium concentrations, even in patients with mild hypontremia (<5 mmol/L below the lower value of the reference interval). Hyponatremia is also associated with increased risk of death if present during specific disease states in dogs.


Assuntos
Doenças do Gato/terapia , Doenças do Cão/terapia , Hiponatremia/veterinária , Solução Salina Hipertônica/uso terapêutico , Animais , Doenças do Gato/sangue , Gatos , Doenças do Cão/sangue , Cães , Esquema de Medicação/veterinária , Hiponatremia/terapia , Infusões Intravenosas/veterinária , Solução Salina Hipertônica/administração & dosagem , Sódio/sangue
6.
Clin Nephrol ; 91(6): 344-352, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30935460

RESUMO

AIMS: We attempted to classify 115 consecutive nonedematous hyponatremic patients according to their history and saline responsiveness. We hereby describe 6 out of them presenting a transient renal salt wasting (TRSW) state of unknown origin. MATERIALS AND METHODS: Six patients with an initial SNa of 126 ± 3 mEq/L were included in the study. They were treated with 2 L isotonic saline infusion over 24 hours. The evolution of the biochemical data of 5 patients were compared to 6 patients with syndrome of inappropriate antidiuretic hormone (ADH) secretion (SIADH), 6 hyponatremias following the use of thiazides, and to 5 salt-depleted hyponatremic patients of similar age and body weight, treated in the same way. RESULTS: The mean values of FEurea and FEuric acid in the 6 described patients, together with a clearly inappropriate natriuresis suggested SIADH. However, the high mean fractional potassium excretion (FEK = 34 ± 15%) was not observed in SIADH (13 ± 3%) (p < 0.01). Plasma sodium levels improved quickly after saline infusion in most of these patients, while fractional solute excretions and diuresis decreased. Calciuria is increased in patients with renal salt waisting (RSW), while low calciuria values are observed in the thiazide group. Four of the 6 hyponatremic patients were admitted for syncopal malaise or fall. CONCLUSION: We observed in 6 out of 115 consecutive hyponatremic patients a TRSW. RSW as a diagnosis has to be considered when in hyponatremia with excessive natriuresis, high FEK and an intake of diuretics is ruled out. This hyponatremia is saline-responsive, but relapse can be frequently observed.


Assuntos
Hiponatremia/sangue , Hiponatremia/etiologia , Nefropatias/sangue , Sódio/sangue , Idoso , Idoso de 80 Anos ou mais , Cálcio/urina , Diurese , Diuréticos/efeitos adversos , Feminino , Hidratação , Humanos , Hiponatremia/terapia , Hiponatremia/urina , Síndrome de Secreção Inadequada de HAD/sangue , Síndrome de Secreção Inadequada de HAD/complicações , Síndrome de Secreção Inadequada de HAD/urina , Soluções Isotônicas , Nefropatias/complicações , Nefropatias/urina , Potássio/urina , Solução Salina/uso terapêutico , Tiazidas/efeitos adversos , Ureia/urina , Ácido Úrico/urina
7.
J Stroke Cerebrovasc Dis ; 28(6): 1674-1683, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30967305

RESUMO

BACKGROUND: Hyponatremia is the most common electrolyte disorder in the clinic practice and it is closely related to the prognosis of various diseases. Studies reported that hyponatremia increased the risk of stroke mortality while yielded inconsistent findings during the follow-up period. Thus, a systematic review and meta-analysis to assess the relationship between hyponatremia and the short-term (within 90 days) and long-term (more than 1 year) prognosis of stroke patients was conducted. METHODS: A computerized systematic literature search was performed before November of 2018 for relevant articles evaluating the relationship between hyponatremia and all-cause mortality risk in stroke patients. Pooled relative risk (RR) and hazard risk (HR) with 95% confidence interval (CI) were calculated using DerSimonian-Laird random-effects model. Subgroup analyses were performed according to the follow-up period, types of stroke, different controls, sample size, and sampling time. RESULTS: A total of 12 studies with 21,973 patients were identified. Compared to the nonhyponatremia patients, hyponatremia was associated with a higher risk of all-cause mortality in short-term (RR 1.61, 95% CI 1.33-1.96; HR 1.78 95% CI 1.19-2.75) and long-term follow-up (RR 1.77, 95% CI 1.27-2.47; HR 2.23,95% CI 1.30-3.82). Subgroups analysis showed the similar results in most subgroups. CONCLUSIONS: This meta-analysis concludes that hyponatremia has a significant prognostic value for short- and long-term prognosis to stroke patients.


Assuntos
Hiponatremia/mortalidade , Sódio/sangue , Acidente Vascular Cerebral/mortalidade , Biomarcadores/sangue , Mortalidade Hospitalar , Humanos , Hiponatremia/sangue , Hiponatremia/diagnóstico , Hiponatremia/terapia , Prognóstico , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Fatores de Tempo
8.
Ugeskr Laeger ; 181(11)2019 Mar 11.
Artigo em Dinamarquês | MEDLINE | ID: mdl-30864540

RESUMO

The standard practice in paediatric departments in Danish hospitals is to prescribe hypotonic maintenance fluids (sodium content 20-40 mmol/l) for children, who are fasting or have a reduced enteral intake. The past decades have provided strong evidence, that this can lead to hypo-natraemia and subsequent neurologic damage or death. We recommend, that prefabricated isotonic solutions containing 140-154 mmol/l of sodium and 5% glucose, with or without an additional 20 mmol/l of potassium, are available as standard maintenance fluid for children in all Danish hospitals.


Assuntos
Hidratação , Hiponatremia , Soluções Hipotônicas , Criança , Humanos , Hiponatremia/terapia , Soluções Hipotônicas/uso terapêutico , Soluções Isotônicas , Sódio
10.
Am J Case Rep ; 20: 258-262, 2019 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-30808857

RESUMO

BACKGROUND Development of syndrome of inappropriate antidiuretic hormone secretion or cerebral salt wasting has been commonly noted in post-traumatic brain injury, and this condition may lead to hyponatremia resulting in cerebral edema and possible cerebral herniation. However, the predominant topographic pattern of edema from hyponatremia has not been well documented. Unlike numerous reports on hyponatremia and vasospasm following aneurysmal subarachnoid hemorrhage, the data for traumatic brain injury patient are still limited. We report on a rare patient with malignant middle cerebral artery infarction as a result of hyponatremia following traumatic brain injury. CASE REPORT A 60-year-old Native American male with significant past medical history of alcoholism, hypertension, and hemorrhagic stroke presented to the emergency department by emergency medical service after he was struck by a vehicle in a hit-and-run incident. The patient sustained multiple abrasions, and he had elevated alcohol levels. His initial Glasgow Coma Score (GCS) was 14 with a confused conversation (V4). Computer tomography (CT) of the head showed 5 mm thickness acute subdural and subarachnoid hemorrhage of right frontal, temporal, and parietal areas, with 3 mm midline shift at the level of foramen of Monro. Traumatic brain injury conservative treatment was initiated as well as alcoholic withdrawal protocols in the intensive care unit. Patient initially improved neurologically despite low sodium levels. He recouped to fully conscious, with a GCS score of 15, at 24 hours after admission. On day 9, he was found unresponsive with a head CT showed malignant right middle cerebral artery infarction, resulted in 15 mm subfalcine herniation. The patient passed away 48 hours later, as patient's family declined further intervention. CONCLUSIONS The management and prevention of post-traumatic vasospasm may be complicated even in asymptomatic and neurologically intact patients. Close neurological monitoring and prevention protocols are important in activating appropriate management.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Hiponatremia/complicações , Infarto da Artéria Cerebral Média/diagnóstico , Infarto da Artéria Cerebral Média/etiologia , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/terapia , Evolução Fatal , Humanos , Hiponatremia/diagnóstico , Hiponatremia/terapia , Masculino , Pessoa de Meia-Idade
11.
Artigo em Inglês | MEDLINE | ID: mdl-30638905

RESUMO

The majority of women are healthy entering pregnancy and do not require measurement of renal function or serum electrolytes. Clinicians must remain alert to the possibility of renal as well as fluid and electrolyte disorders in pregnancy, as the presenting complaints are often vague and mistaken for the normal physiology of pregnancy. In this chapter, our objectives are 1) to review the renal physiology from a practical/clinical standpoint; 2) to provide the clinical obstetrician a case-based approach to fluid and electrolyte disorders commonly encountered in pregnancy; 3) to consolidate knowledge on renal physiology and fluid and electrolyte disorders in pregnancy with MCQs that are directly aligned with content; and 4) to highlight key practice points and present a research agenda.


Assuntos
Diabetes Insípido/terapia , Hipopotassemia/terapia , Hiponatremia/terapia , Complicações na Gravidez/fisiopatologia , Complicações na Gravidez/terapia , Desequilíbrio Hidroeletrolítico/fisiopatologia , Diabetes Insípido/diagnóstico , Diabetes Insípido/fisiopatologia , Feminino , Humanos , Hipopotassemia/diagnóstico , Hipopotassemia/fisiopatologia , Hiponatremia/diagnóstico , Hiponatremia/fisiopatologia , Rim/fisiopatologia , Gravidez , Complicações na Gravidez/diagnóstico
13.
BMJ Case Rep ; 12(1)2019 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-30696651

RESUMO

Gitelman syndrome is the most common renal tubulopathy, recently exhibiting a dramatic rise of incidence in Asia.A 50-year-old woman presented with vomiting, fatigue and quadriparesis. Physical examination revealed a positive Trousseau sign , hypotonia and areflexia.Suspecting hypocalcaemia, she was given intravenous 10% calcium gluconate (10 mL administered slowly over 10 min) but her manifestations persisted. An exhaustive laboratory work up revealed the diagnosis of Gitelman syndrome.The peculiarity of this case however, is entailed in its coexistence with hypocalcaemia and hyponatraemia. In addition, the age of primary presentation being 50 years further culminates its atypicality.Multiple electrolyte imbalances were corrected by oral and intravenous supplementation and a high sodium-potassium diet was advocated. Administration of spironolactone imposed a pitfall in the management of our patient due to exacerbation of pre-existing hyponatraemia.On follow-up, her electrolyte profile was stable and corresponding symptoms were alleviated.


Assuntos
Síndrome de Gitelman/complicações , Síndrome de Gitelman/diagnóstico , Hipocalcemia/etiologia , Hiponatremia/etiologia , Ácido Aspártico/uso terapêutico , Gluconato de Cálcio/uso terapêutico , Diagnóstico Diferencial , Feminino , Síndrome de Gitelman/terapia , Humanos , Hipocalcemia/terapia , Hiponatremia/terapia , Pessoa de Meia-Idade , Cloreto de Potássio/uso terapêutico , Potássio na Dieta/uso terapêutico , Solução Salina/uso terapêutico
14.
J Matern Fetal Neonatal Med ; 32(16): 2711-2715, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29526150

RESUMO

BACKGROUND: Hyponatremia during labor and delivery may result in severe maternal and neonatal sequelae. Our aim was to describe the direct effect of hyponatremia in labor on pregnancy outcome. METHODS: A case series of parturients diagnosed with hyponatremia during labor and their neonates. Clinical presentation, laboratory workup, and maternal and neonatal outcomes are presented. RESULTS: Four parturients and their corresponding six neonates were diagnosed with hyponatremia. Of these, two cases were caused by water intoxication and two were preeclampsia induced. While two were identified due to maternal or neonatal symptoms, two were diagnosed by routine laboratory testing. In all cases, low maternal sodium resulted in similarly low neonatal sodium. Neonatal symptoms included respiratory distress syndrome (RDS), lethargy, and jaundice. CONCLUSION: Psychogenic drinking during labor and preeclampsia may predispose to maternal hyponatremia, resulting in neonatal hyponatremia. Early recognition and treatment can prevent further maternal deterioration and adverse neonatal sequelae.


Assuntos
Hiponatremia/etiologia , Doenças do Recém-Nascido/etiologia , Pré-Eclâmpsia/fisiopatologia , Intoxicação por Água/complicações , Adulto , Anestesia Epidural/efeitos adversos , Feminino , Humanos , Hiponatremia/sangue , Hiponatremia/terapia , Síndrome de Secreção Inadequada de HAD/complicações , Recém-Nascido , Doenças do Recém-Nascido/sangue , Doenças do Recém-Nascido/terapia , Trabalho de Parto/sangue , Trabalho de Parto/fisiologia , Masculino , Pessoa de Meia-Idade , Gravidez , Resultado da Gravidez
15.
Acta Clin Belg ; 74(1): 7-20, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30311550

RESUMO

The differential diagnosis between hypertonic, isotonic and hypotonic hyponatremia are presented. The help of some usual serum (urea, uric acid and TCO2) and urine parameters (mainly osmolality and sodium concentration) are discussed and help to determine the best treatment. Morbidity associated with untreated hyponatremia and with the different treatment available is also discussed. Who to prevent and treat ODS (osmotic demyelating syndrome) is recalled. The pathophysiology and treatment of hypernatremia are also discussed.


Assuntos
Hiponatremia/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Hipernatremia/sangue , Hipernatremia/diagnóstico , Hipernatremia/terapia , Hipernatremia/urina , Hiponatremia/sangue , Hiponatremia/terapia , Hiponatremia/urina , Masculino , Sódio/sangue
16.
Saudi J Kidney Dis Transpl ; 29(6): 1470-1474, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30588980

RESUMO

Optimal treatment of severe hyponatremia in patients requiring dialysis is not known. Rapid correction with the use of different dialysis modalities can lead to osmotic demyelination syndrome. We described a safe correction of severe hyponatremia in a 42-year-old male patient requiring dialysis, who was treated with continuous venovenous hemofiltration using hypotonic replacement fluid which was prepared and adjusted on a daily basis.


Assuntos
Hemofiltração/métodos , Hiponatremia/terapia , Soluções Hipotônicas/administração & dosagem , Insuficiência Renal/terapia , Sódio/administração & dosagem , Adulto , Biomarcadores/sangue , Hemofiltração/efeitos adversos , Humanos , Hiponatremia/sangue , Hiponatremia/diagnóstico , Hiponatremia/fisiopatologia , Masculino , Insuficiência Renal/sangue , Insuficiência Renal/diagnóstico , Insuficiência Renal/fisiopatologia , Índice de Gravidade de Doença , Sódio/sangue , Resultado do Tratamento , Equilíbrio Hidroeletrolítico
17.
Medicine (Baltimore) ; 97(49): e13389, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30544413

RESUMO

To determine the incidence, clinical features, etiology, risk factors, and mortality in internal medicine patients with hyponatremia (P-Na).A prospective survey was conducted in patients with P-Na, diagnosed at admission in an Internal Medicine Department. 692 patients were then selected and subsequently divided into 3 groups based on the severity of P-Na. Multivariate linear regression analysis was used to explore the factors associated with levels of P-Na.The prevalence of P-Na was 3.37%. Euvolemia P-Na was the predominant subtype in 3 types of P-Na (49.42%). Gastrointestinal and neurological manifestations were common hyponatremic symptoms. The leading 5 underlying diagnoses were chest infection (31.94%), malignancy (10.84%), cardiac disease (6.36%), liver cirrhosis (6.07%), and neurological disease (5.20%). Moderate and severe P-Na had higher mortalities than mild P-Na (P <.05). For the levels of serum Na, Age, and serum Cl were positively correlated while serum K, blood urea nitrogen (BUN), and Glu were negatively correlated (P <.05).P-Na is common in internal medicine and accompanied by other electrolyte disturbances, various symptoms/diagnoses, and increased mortalities with decreasing Na, which requires special attention in clinical practice.


Assuntos
Hiponatremia/epidemiologia , China/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Hiponatremia/diagnóstico , Hiponatremia/fisiopatologia , Hiponatremia/terapia , Medicina Interna , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
18.
BMC Endocr Disord ; 18(1): 93, 2018 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-30522474

RESUMO

BACKGROUND: Hyponatraemia is the most common electrolyte disturbance amongst hospitalised patients. Both American and European guidelines recommend fluid restriction as first line treatment for SIADH, however differ on second line recommendations. The objective of this study was to examine investigation and management of hyponatraemia in hospitalised patients in an Australian tertiary hospital. METHODS: A retrospective audit was conducted of electronic medical records and laboratory data of inpatients with serum sodium (Na) ≤125 mmol/L, admitted over a 3 month period to the Princess Alexandra Hospital, Brisbane, Australia. The main outcomes measured included: demographic characteristics, investigations, accuracy of diagnosis, management strategy, change in Na and patient outcomes. RESULTS: The working clinical diagnosis was considered accurate in only 37.5% of cases. Urine Na and osmolality were requested in 72 of 152 patients (47.4%) and in 43 of 70 euvolaemic patients (61.4%). Thyroid function tests (67.1%) and morning cortisol (45.7%) were underutilized in the euvolaemic group. In the SIADH cohort, fluid restriction resulted in a median (IQR) 7.5 mmol/L (4-10.5) increase in Na after 3 days; no treatment resulted in a median 0 mmol/L (- 0.5-1.5) change. Oral urea was utilized in 5 SIADH patients where Na failed to increase with fluid restriction alone. This resulted in a median 10.5 mmol/L (3.5-13) increase in Na from baseline to day 3. There were no cases of osmotic demyelination. The median length of stay was 8 days (4-18.5). Mortality was 11.2% (17 patients). There was a weak but significant correlation between nadir serum Na and mortality (R = 0.18, P = 0.031). CONCLUSION: Inpatient hyponatraemia is often inadequately investigated, causing errors in diagnosis. Treatment is heterogeneous and often incorrect. In cases with hyponatraemia refractory to fluid restriction, oral urea presents an effective alternative treatment.


Assuntos
Gerenciamento Clínico , Hospitalização/tendências , Hiponatremia/diagnóstico , Hiponatremia/terapia , Índice de Gravidade de Doença , Centros de Atenção Terciária/tendências , Idoso , Estudos de Coortes , Feminino , Hidratação/tendências , Humanos , Hiponatremia/metabolismo , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Solução Salina Hipertônica/uso terapêutico , Ureia/uso terapêutico
19.
Artigo em Inglês | MEDLINE | ID: mdl-30539703

RESUMO

Idiopathic Edema (IE), is a syndrome involving real or perceived weight gain secondary to the pathological retention of fluid. This syndrome of generalized edema is almost solely reported in women. The diagnosis of IE is one of exclusion and requires a careful history, physical exam, and clinical suspicion. The aim of this article is to provide a comprehensive review of the available literature in order to attempt to define IE, identify the possible causes, review the proposed pathophysiology, and discuss potential treatment options.


Assuntos
Edema/etiologia , Edema/patologia , Animais , Edema/fisiopatologia , Edema/terapia , Humanos , Hiponatremia/etiologia , Hiponatremia/patologia , Hiponatremia/fisiopatologia , Hiponatremia/terapia , Linfedema/etiologia , Linfedema/patologia , Linfedema/fisiopatologia , Linfedema/terapia , Síndrome Nefrótica/etiologia , Síndrome Nefrótica/patologia , Síndrome Nefrótica/fisiopatologia , Síndrome Nefrótica/terapia , Síndromes da Apneia do Sono/etiologia , Síndromes da Apneia do Sono/patologia , Síndromes da Apneia do Sono/fisiopatologia , Síndromes da Apneia do Sono/terapia , Ganho de Peso
20.
Pediatrics ; 142(6)2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30478247

RESUMO

Maintenance intravenous fluids (IVFs) are used to provide critical supportive care for children who are acutely ill. IVFs are required if sufficient fluids cannot be provided by using enteral administration for reasons such as gastrointestinal illness, respiratory compromise, neurologic impairment, a perioperative state, or being moribund from an acute or chronic illness. Despite the common use of maintenance IVFs, there is high variability in fluid prescribing practices and a lack of guidelines for fluid composition administration and electrolyte monitoring. The administration of hypotonic IVFs has been the standard in pediatrics. Concerns have been raised that this approach results in a high incidence of hyponatremia and that isotonic IVFs could prevent the development of hyponatremia. Our goal in this guideline is to provide an evidence-based approach for choosing the tonicity of maintenance IVFs in most patients from 28 days to 18 years of age who require maintenance IVFs. This guideline applies to children in surgical (postoperative) and medical acute-care settings, including critical care and the general inpatient ward. Patients with neurosurgical disorders, congenital or acquired cardiac disease, hepatic disease, cancer, renal dysfunction, diabetes insipidus, voluminous watery diarrhea, or severe burns; neonates who are younger than 28 days old or in the NICU; and adolescents older than 18 years old are excluded. We specifically address the tonicity of maintenance IVFs in children.The Key Action Statement of the subcommittee is as follows:1A: The American Academy of Pediatrics recommends that patients 28 days to 18 years of age requiring maintenance IVFs should receive isotonic solutions with appropriate potassium chloride and dextrose because they significantly decrease the risk of developing hyponatremia (evidence quality: A; recommendation strength: strong).


Assuntos
Cuidados Críticos/normas , Estado Terminal/terapia , Hidratação/normas , Hiponatremia/terapia , Hipovolemia/tratamento farmacológico , Soluções Isotônicas/administração & dosagem , Guias de Prática Clínica como Assunto , Criança , Humanos , Hiponatremia/metabolismo , Infusões Intravenosas
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