Fluid and Electrolyte Therapy in Children

A special issue of Children (ISSN 2227-9067).

Deadline for manuscript submissions: closed (25 July 2022) | Viewed by 34675

Special Issue Editor

UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA 15224, USA
Interests: hyponatremia; hypernatremia; maintenance fluid therapy

Special Issue Information

Dear Colleagues,

Fluid and electrolyte therapy play a critical role in the management of acutely ill children. Various electrolyte disorders are encountered in acutely ill children which require expertise in their evaluation and management. Fluid resuscitation is required to restore and maintain perfusion, though excessive fluid administration is associated with mortality. Recent guidelines have been developed for fluid therapy maintenance, recommending the use of isotonic fluids to prevent the development of hospital-acquired hyponatremia.

A yet unresolved issue is whether isotonic fluid contributes to acute kidney injury and mortality in comparison to balanced solutions. The syndrome of inappropriate antidiuresis is one of the most common causes of hyponatremia in hospitalized children, yet controversy exists regarding the prevalence of cerebral or renal salt wasting. Recent studies have demonstrated the safety and efficacy of administering hypertonic saline through a peripheral IV for the treatment of hyponatremic encephalopathy, yet there are ongoing barriers to its use. New treatment therapies are available for hyponatremia, including vasopressin receptor antagonists and oral urea. The roles for these therapies in children are still evolving.

Hyponatremia and hypernatremia have been demonstrated to be independent risk factors for mortality, with the reasons for this still being elucidated. Hypernatremia in children has many causes, an important one being breastfeeding-associated hypernatremia. Debate exists between measures to promote successful breastfeeding and preventing the development of breastfeeding-associated hypernatremia. We welcome contributions which advance our understanding of fluid therapy in children.

Dr. Michael L. Moritz
Guest Editor

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Keywords

  • hyponatremia
  • hypernatremia
  • fluid therapy
  • fluid resuscitation
  • hypertonic saline
  • syndrome of inappropriate antidiuresis

Published Papers (5 papers)

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7 pages, 1494 KiB  
Article
Balanced Crystalloids versus Normal Saline in Children with Critical Asthma
by Andrea Scioscia, Christopher Horvat, Michael L. Moritz and Dana Fuhrman
Children 2022, 9(10), 1480; https://0-doi-org.brum.beds.ac.uk/10.3390/children9101480 - 28 Sep 2022
Cited by 3 | Viewed by 1451
Abstract
There is little known about the impact of maintenance fluid choice in children with critical asthma on clinical outcomes. Our primary study objectives were to determine the differences in the serum chloride and bicarbonate levels based on the receipt of 0.9% saline or [...] Read more.
There is little known about the impact of maintenance fluid choice in children with critical asthma on clinical outcomes. Our primary study objectives were to determine the differences in the serum chloride and bicarbonate levels based on the receipt of 0.9% saline or a balanced solution. The secondary study objectives included differences in acute kidney injury (AKI) and intensive care unit (ICU)/hospital length of stay (LOS). In this retrospective cohort study, we included 1166 patients admitted to a quaternary children’s hospital with critical asthma between 2017 and 2019. The patients were stratified based on if they received 0.9% saline or a balanced solution (Lactated Ringer’s or Plasma-lyte) for maintenance therapy. The study outcomes were determined using independent sample t-tests, multivariable logistic regression, and negative binomial regression. The patients who received 0.9% saline maintenance therapy had a significantly higher increase in their serum chloride levels when compared to those who received balanced solutions (0.9% saline: +4 mMol/L, balanced: +2 mMol/L, p = 0.002). There was no difference in the decrease in the serum bicarbonate levels (0.9% saline: −0.4 mMol/L, balanced: −0.5 mMol/L, p = 0.830). After controlling for age, race, sex, and the Pediatric Logistic Organ Dysfunction (PELOD-2) score, there was no association between the type of fluid received and the development of AKI (OR 0.87, 95% CI: 0.46–1.63, p = 0.678). Additionally, there was no association between the type of fluid and hospital or ICU LOS. Thus, despite higher serum chloride levels in the patients that received 0.9% saline, the choice of fluid therapy did not have an impact on the serum bicarbonate values, the development of AKI or hospital and ICU LOS, suggesting there is little difference between 0.9% saline and balanced solutions as maintenance therapy in children with critical asthma. Full article
(This article belongs to the Special Issue Fluid and Electrolyte Therapy in Children)
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11 pages, 632 KiB  
Article
Copeptin Concentrations in Plasma of Healthy Neonates in Relation to Water–Electrolyte Homeostasis in the Early Adaptation Period
by Anna Jarosz-Lesz, Aniceta Brzozowska and Iwona Maruniak-Chudek
Children 2022, 9(3), 443; https://0-doi-org.brum.beds.ac.uk/10.3390/children9030443 - 21 Mar 2022
Viewed by 1688
Abstract
Copeptin (CTproAVP) is a stable by-product of arginine–vasopressin synthesis and reflects its secretion by the pituitary gland, considered as a potential new marker of dehydration. The objective of the study was to investigate CTproAVP measured after the first 48 h of postnatal life [...] Read more.
Copeptin (CTproAVP) is a stable by-product of arginine–vasopressin synthesis and reflects its secretion by the pituitary gland, considered as a potential new marker of dehydration. The objective of the study was to investigate CTproAVP measured after the first 48 h of postnatal life in relation to serum effective osmolality, urine osmolality, and vessels filling according to the following variables: delivery mode, postnatal weight loss, fluids administered intravenously to the mother, and fluids given orally to the neonate. A prospective observational study was conducted with 200 healthy term infants (53% male) enrolled. Serum CTproAVP concentrations were measured using the ELISA kit; haematocrit, urine osmolality, serum effective osmolality were assessed after 48 h of life. Sonographic measurements of inferior vena cava (IVC) and aorta (Ao) were performed and IVC/Ao ratios were calculated. No correlations were found between CTproAVP concentrations and both serum effective osmolality and urine osmolality. There was also no association between CTproAVP concentrations and vessel filling represented by IVC/Ao index at 48 h of life. Full article
(This article belongs to the Special Issue Fluid and Electrolyte Therapy in Children)
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19 pages, 2573 KiB  
Article
Efficacy and Safety of Isotonic and Hypotonic Intravenous Maintenance Fluids in Hospitalised Children: A Systematic Review and Meta-Analysis of Randomised Controlled Trials
by Norfarahin Hasim, Mimi Azliha Abu Bakar and Md Asiful Islam
Children 2021, 8(9), 785; https://0-doi-org.brum.beds.ac.uk/10.3390/children8090785 - 08 Sep 2021
Cited by 9 | Viewed by 4678
Abstract
Hyponatraemia is a known complication in hospitalised children receiving maintenance intravenous fluid. Several studies have been published to investigate the efficacy and safety of intravenous fluids in children. However, there is still an ongoing debate regarding the ideal solution to be used in [...] Read more.
Hyponatraemia is a known complication in hospitalised children receiving maintenance intravenous fluid. Several studies have been published to investigate the efficacy and safety of intravenous fluids in children. However, there is still an ongoing debate regarding the ideal solution to be used in the paediatric population. Therefore, the aim of this meta-analysis was to investigate the safety and efficacy of administering isotonic versus hypotonic intravenous maintenance fluid in hospitalised children. An extensive search was undertaken on PubMed, Web of Science, Scopus, ScienceDirect, Google Scholar and Cochrane Library on 28 December 2020. Only randomised controlled trials (RCTs) were included. We used the random-effects model for all analyses. Risk ratio (RR) and mean difference with 95% confidence intervals (CIs) were used for dichotomous and continuous outcomes, respectively. The quality of each study was assessed using the Joanna Briggs Institute critical appraisal tool for RCTs. This study is registered with PROSPERO (CRD42021229067). Twenty-two RCTs with a total of 3795 participants were included. The studies encompassed surgical and medical patients admitted to intensive care unit as well as to general wards. We found that hypotonic fluid significantly increases the risk of hyponatremia at both ≤24 h (RR 0.34; 95% CI: 0.26–0.43, p < 0.00001) and >24 h (RR 0.48; 95% CI: 0.36–0.64, p < 0.00001). Isotonic fluid increases the risk of hypernatraemia at ≤24 h (RR 2.15; 95% CI: 1.24–3.73, p = 0.006). The prevalence of hyponatraemia was also higher in the hypotonic group at both ≤24 h (5.7% vs. 23.3%) and >24 h (6.0% vs. 26.3%). There was no statistically significant difference in the risk of developing adverse outcomes between the two groups. Mean serum and urine sodium as well as serum osmolality/osmolarity was lower in the hypotonic group. Isotonic solution is protective against the development of hyponatraemia while hypotonic solution increases the risk of hyponatraemia. Full article
(This article belongs to the Special Issue Fluid and Electrolyte Therapy in Children)
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17 pages, 321 KiB  
Case Report
Fatal Hypernatremic Dehydration in a Term Exclusively Breastfed Newborn
by Christie del Castillo-Hegyi, Jennifer Achilles, B. Jody Segrave-Daly and Lynnette Hafken
Children 2022, 9(9), 1379; https://0-doi-org.brum.beds.ac.uk/10.3390/children9091379 - 13 Sep 2022
Cited by 3 | Viewed by 23058
Abstract
Hypernatremic dehydration in term newborns has steadily increased in incidence with increasing efforts to promote exclusive breastfeeding before hospital discharge, a key metric of the Baby-Friendly Hospital Initiative. The following report details a case of a term newborn infant who had evidence of [...] Read more.
Hypernatremic dehydration in term newborns has steadily increased in incidence with increasing efforts to promote exclusive breastfeeding before hospital discharge, a key metric of the Baby-Friendly Hospital Initiative. The following report details a case of a term newborn infant who had evidence of poor intake while exclusively breastfeeding during his hospital stay that may not have been recognized by health care providers. The infant was discharged home and was subsequently found by the parents in cardiac arrest 12 h after discharge and was found to have hypernatremic dehydration. Although return of spontaneous circulation was achieved after fluid resuscitation, the infant sustained extensive hypoxic-ischemic brain injury due to cardiovascular collapse. Due to the infant’s extremely poor prognosis, life support was withdrawn at 19 days of age and the infant expired. This sentinel case demonstrates multiple pitfalls of current perceptions of normal vs. abnormal newborn feeding behavior, weight loss percentages, elimination patterns, and acceptable clinical thresholds believed to be safe for neonates. Newer data have shown that hypernatremia occurs commonly in healthy, term breastfed newborns at weight loss percentages previously deemed normal by most health professionals and hospital protocols. In-hospital strategies to prevent excessive weight loss and screening for hypernatremia in response to signs of inadequate feeding have the potential to prevent tens of thousands of readmissions for feeding complications a year, as well as hundreds of millions in health care costs. Full article
(This article belongs to the Special Issue Fluid and Electrolyte Therapy in Children)
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5 pages, 703 KiB  
Case Report
Regulation of Serum Sodium Levels during Chemotherapy Using Selective Arginine Vasopressin V2-Receptor Antagonist Tolvaptan in a Four-Year-Old Girl with a Suprasellar Germ Cell Tumor
by Shota Hiroshima, Hiromi Nyuzuki, Sunao Sasaki, Yohei Ogawa and Keisuke Nagasaki
Children 2021, 8(4), 293; https://0-doi-org.brum.beds.ac.uk/10.3390/children8040293 - 10 Apr 2021
Cited by 1 | Viewed by 2266
Abstract
There are limited reports on the use of tolvaptan for syndrome of inappropriate antidiuretic hormone secretion (SIADH) in children. Managing serum sodium levels in SIADH patients during chemotherapy is often difficult because of the need for massive fluid infusions. We report the course [...] Read more.
There are limited reports on the use of tolvaptan for syndrome of inappropriate antidiuretic hormone secretion (SIADH) in children. Managing serum sodium levels in SIADH patients during chemotherapy is often difficult because of the need for massive fluid infusions. We report the course of the use of tolvaptan for the treatment of hyponatremia during chemotherapy in a four-year-old girl with a suprasellar germ cell tumor. The patient was a Japanese girl who presented with left ptosis with a mass in the pituitary gland and cavernous sinus. She was diagnosed with an intermediate-grade germ cell tumor and was treated with carboplatin and etoposide combination chemotherapy. She developed hyponatremia due to SIADH caused by intravenous infusion therapy before chemotherapy. Subsequently, tolvaptan (3.25 mg; 0.20 mg/kg/dose) was administered orally to control serum sodium levels. After 4 h of administration, a marked increase in urine volume of up to 15 mL/kg/h was observed, and serum sodium level increased from 126 to 138 mEq/L after 10 h of tolvaptan administration, followed by a decrease in urine volume. The use of tolvaptan in pediatric patients with SIADH who require intravenous hydration during chemotherapy can be useful for the management of serum sodium balance. Full article
(This article belongs to the Special Issue Fluid and Electrolyte Therapy in Children)
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