Moritz Michael L, Ayus Juan Carlos
Division of Nephrology, Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh School Medicine, Pittsburgh, Pennsylvania 15213-2538, USA.
Pediatrics. 2003 Feb;111(2):227-30. doi: 10.1542/peds.111.2.227.
The current standard of care in pediatrics is to administer hypotonic saline in maintenance parenteral fluids. The safety of this approach has never been evaluated.
A review of the literature reveals that the administration of hypotonic fluids is potentially dangerous and may not be physiologic for the hospitalized child.
There have been >50 reported cases of neurologic morbidity and mortality, including 26 deaths, in the past 10 years resulting from hospital-acquired hyponatremia in children who were receiving hypotonic parenteral fluids. Common childhood conditions requiring parenteral fluids, such as pulmonary and central nervous system infections, dehydration, and the postoperative state, are associated with a nonosmotic stimulus for antidiuretic hormone production, which can lead to free water retention and hyponatremia. Children are at particularly high risk of developing symptomatic hyponatremia as they have a larger brain-to-skull size ratio.
The administration of isotonic saline in maintenance parenteral fluids is the most important prophylactic measure that can be taken to prevent the development of hyponatremia in children who receive parenteral fluids.
儿科目前的护理标准是在维持性肠外补液中使用低渗盐水。这种方法的安全性从未得到评估。
文献综述显示，给予低渗液可能具有危险性，且对住院儿童而言可能不符合生理情况。
在过去10年中，已有超过50例因接受低渗肠外补液的儿童发生医院获得性低钠血症而导致神经功能障碍和死亡的病例报告，其中包括26例死亡。需要肠外补液的常见儿童疾病，如肺部和中枢神经系统感染、脱水及术后状态，与抗利尿激素分泌的非渗透性刺激有关，这可能导致自由水潴留和低钠血症。儿童因脑与颅骨的大小比例较大，发生有症状性低钠血症的风险特别高。
在维持性肠外补液中使用等渗盐水是预防接受肠外补液儿童发生低钠血症的最重要预防措施。
