Jorro Barón Facundo A, Meregalli Claudia N, Rombolá Valeria A, Bolasell Cecilia, Pigliapoco Vilma E, Bartoletti Silvia E, Debaisi Gustavo E
Pediatric Intensive Care Unit, Hospital de Niños Pedro de Elizalde, Buenos Aires City, Argentina.
Arch Argent Pediatr. 2013 Jul-Aug;111(4):281-7. doi: 10.5546/aap.2013.eng.281.
Hypotonic fluids have been associated with the development of iatrogenic hyponatremia.
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).
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.
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).
Neither hypotonic nor isotonic maintenance fluids increased the risk of developing iatrogenic hyponatremia with the 24 hour infusion.
低渗性液体与医源性低钠血症的发生有关。
评估静脉输注等渗维持液（0.9%氯化钠/5%葡萄糖）与低渗维持液（0.45%氯化钠/5%葡萄糖）后血清钠（sNa）的变化。
随机、对照、双盲临床试验。纳入预计在重症监护病房住院时间超过24小时、血清钠正常且静脉补液量超过总维持液量80%的儿科患者。在给予维持液前及将补液量减少至总液量的<80%时测量血清钠水平。
该研究纳入63例患者，随机分为接受低渗（n = 32）或等渗（n = 31）维持液组。两组基线特征相似。补液量（低渗组：865±853 mL；等渗组：778±649 mL；p = 0.654）或输注持续时间（低渗组：24±10.8小时；等渗组：27.6±12.8小时；p = 0.231）无差异。给予维持液后血清钠存在差异（低渗组：137.8±4.3 mmol/L；等渗组：140.0±4.1 mmol/L，p = 0.04）。这两种维持液均未增加低钠血症（血清钠<135 mmol/L）或高钠血症（血清钠>145 mmol/L）的风险。
24小时输注时，低渗和等渗维持液均未增加发生医源性低钠血症的风险。
