• About
  • Masthead
  • License Content
  • Advertise
  • Submit Press Release
  • RSS/Email List
  • Write for us
  • Contact us
2 Minute Medicine
No Result
View All Result

No products in the cart.

SUBSCRIBE
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • The Scan
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
2 Minute Medicine
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • The Scan
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
SUBSCRIBE
2 Minute Medicine
Subscribe
Home All Specialties Emergency

Balanced intravenous solutions reduce risk of hyperchloremia in the pediatric intensive care unit

byMolly MunsellandAlex Gipsman, MD
January 5, 2023
in Emergency, Nephrology, Pediatrics
Reading Time: 3 mins read
0
Share on FacebookShare on Twitter

1. In a randomized controlled trial of critically ill pediatric patients requiring intravenous fluid therapy, children receiving saline were significantly more likely to have a serum chloride rise of 5 mEq/L than those receiving either gluconate/acetate-buffered solution or lactate-buffered solution.

2. The odds of a serum chloride rise within 48 hours were reduced by 50% in children receiving gluconate/acetate-buffered solution and 53% in those receiving lactate-buffered solution compared to the group receiving saline.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Children admitted to pediatric intensive care units (PICUs) for a variety of causes often require intravenous fluid therapy. This randomized trial aimed to assess the potential benefit of using balanced solutions (gluconate/acetate-buffered solution or lactate-buffered solution) compared with saline (0.9% sodium chloride) in preventing rises in serum chloride. Among 516 randomized critically ill patients, the incidence of an increase in serum chloride by at least 5 mEq/L was 25.2% in the group receiving gluconate/acetate-buffered solution, 23.9% in the lactate-buffered solution group, and 40.0% in the saline group. The odds of a serum chloride rise were significantly reduced in both the buffered solution groups compared to the saline group. There were no significant differences in secondary outcomes, including rates of acute kidney injury, organ-dysfunction-free survival, or length of PICU stay, between groups. This study convincingly shows a decreased risk of rising serum chloride levels when a buffered solution is used as opposed to 0.9% sodium chloride for intravenous fluid therapy. However, patients had received a median of 26.2 mL/kg of intravenous fluid before randomization, which limits the interpretation of these findings with respect to initial fluid resuscitation. The relative clinical significance of hyperchloremia is also not entirely clear, although a previous retrospective study linked a 5 mEq/L serum chloride increase in critically ill children with significantly increased adjusted odds of mortality. Though further study using clinical outcomes would provide additional value, this study supports the increasingly common use of buffered solutions over saline in the PICU setting.

Click to read the study in JAMA Pediatrics

Relevant Reading: ESPNIC clinical practice guidelines: Intravenous maintenance fluid therapy in acute and critically ill children— A systematic review and meta-analysis

In-Depth [randomized controlled trial]: Children younger than age 16 admitted to a single PICU in Australia between 2019 and 2021 were included. Screening took place within 24 hours of PICU admission, and non-blinded, 1:1:1 randomization was within 4 hours of the beginning of intravenous fluid therapy. The assigned fluid was used for both maintenance and bolus therapy. Patients with baseline hyponatremia, cardiac or renal disease, burns, and certain other diseases affecting serum electrolytes were excluded. Patients in the gluconate/acetate-buffered solution, lactate-buffered solution, and saline groups received a median of 33.7, 39.9, and 42.1 mL/kg intravenous fluid after randomization, respectively. Based on the primary intention-to-treat analysis, the odds ratio of a serum chloride rise of 5 mEq/L or more in the gluconate/acetate-buffered solution group compared to the saline group was 0.50 [95% confidence interval (CI) 0.31-0.83; p=0.007]. For the lactate-buffered solution group, this odds ratio was 0.47 (95% CI 0.28-0.79; p=0.004). The decrease in odds of a serum chloride rise with buffered solution was more pronounced in infants younger than 6 months and in nonelective admissions.

RELATED REPORTS

Active surveillance strategies to improve rates of inferior vena cava filter retrieval

2 Minute Medicine Rewind March 20, 2023

Nosocomial infections in children supported by veno-arterial extracorporeal membrane oxygenation

Image: PD

©2023 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.

Tags: critical carefluid resuscitationintravenous fluidspediatric intensive care unitsepsis
Previous Post

#VisualAbstract: Prophylactic methylprednisolone for cardiac surgery in infants does not improve post-operative outcomes

Next Post

Intimate partner violence associated with poor socioemotional development in children

RelatedReports

Thrombophilia-associated stillbirth risk appears limited to factor V Leiden
Cardiology

Active surveillance strategies to improve rates of inferior vena cava filter retrieval

March 22, 2023
Intensive rehabilitation not superior to traditional therapy for arm function after stroke
Weekly Rewinds

2 Minute Medicine Rewind March 20, 2023

March 20, 2023
Large proportion of late preterm infants and older admitted to the NICU
Infectious Disease

Nosocomial infections in children supported by veno-arterial extracorporeal membrane oxygenation

February 27, 2023
2 Minute Rewind November 29, 2021
Weekly Rewinds

2 Minute Medicine Rewind February 27, 2023

February 27, 2023
Next Post
Meeting families, demographic information affect child abuse work-up

Intimate partner violence associated with poor socioemotional development in children

FDA-approved weight loss medications associated with weight loss at one year

Christian Orthodox Church fasting may improve metabolic syndrome risk factors

Fewer work hours linked to greater likelihood of continued breastfeeding

Labour epidural analgesia not associated with decreased exclusive breastfeeding rates

License Our Award-Winning Physician-Written Medical News and Visual Abstracts

2 Minute Medicine is the leading authoritative medical news licensing service, and the only with reports written by practicing doctors.

LICENSE CONTENT

2MM+ Premium Access

No ads & unlimited access to all current reports, over 9000 searchable archived reports, visual abstracts, Weekly Rewinds, and the online edition of The Classics Series™ textbook.

Subscription Options
2 Minute Medicine

2 Minute Medicine® is an award winning, physician-run, expert medical media company. Our content is curated, written and edited by practicing health professionals who have clinical and scientific expertise in their field of reporting. Our editorial management team is comprised of highly-trained MD physicians. Join numerous brands, companies, and hospitals who trust our licensed content.

Recent Reports

  • Mycobacterium abscessus infections after cardiac surgery linked to hospital water system
  • The 2 Minute Medicine Podcast Episode 11
  • Wellness Check: Spirituality
License Content
Terms of Use | Disclaimer
Cookie Policy
Privacy Statement (EU)
Disclaimer

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • The Scan
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

Want more physician-written
medical news?

Join over 10 million yearly readers and numerous companies. For healthcare professionals
and the public.

Subscribe for free today!

Subscription options