Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, CA; Air Force Institute of Technology, Wright-Patterson Air Force Base, Dayton, OH.
J Pediatr. 2013 Dec;163(6):1646-51. doi: 10.1016/j.jpeds.2013.07.020. Epub 2013 Aug 30.
To evaluate whether the administration of hypotonic fluids compared with isotonic fluids is associated with a greater risk for hyponatremia in hospitalized children.
Informatics-enabled cohort study of all hospitalizations at Lucile Packard Children's Hospital between April 2009 and March 2011. Extraction and analysis of electronic medical record data identified normonatremic hospitalized children who received either hypotonic or isotonic intravenous maintenance fluids upon admission. The primary exposure was the administration of hypotonic maintenance fluids, and the primary outcome was the development of hyponatremia (serum sodium <135 mEq/L).
A total of 1048 normonatremic children received either hypotonic (n = 674) or isotonic (n = 374) maintenance fluids upon admission. Hyponatremia developed in 260 (38.6%) children who received hypotonic fluids and 104 (27.8%) of those who received isotonic fluids (unadjusted OR 1.63; 95% CI 1.24-2.15, P < .001). After we controlled for intergroup differences and potential confounders, patients receiving hypotonic fluids remained more likely to develop hyponatremia (aOR 1.37, 95% CI 1.03-1.84). Multivariable analysis identified additional factors associated with the development of hyponatremia, including surgical admission (aOR 1.44, 95% CI 1.09-1.91), cardiac admitting diagnosis (aOR 2.08, 95% CI 1.34-3.20), and hematology/oncology admitting diagnosis (aOR 2.37, 95% CI 1.74-3.25).
Hyponatremia was common regardless of maintenance fluid tonicity; however, the administration of hypotonic maintenance fluids compared with isotonic fluids was associated with a greater risk of developing hospital-acquired hyponatremia. Additional clinical characteristics modified the hyponatremic effect of hypotonic fluid, and it is possible that optimal maintenance fluid therapy now requires a more individualized approach.
评估与等渗液相比，低渗液的给药是否与住院儿童低钠血症的风险增加相关。
这是一项 2009 年 4 月至 2011 年 3 月在露西尔·帕卡德儿童医院进行的基于信息学的住院患儿队列研究。提取和分析电子病历数据，确定入院时接受低渗或等渗静脉维持液的正常钠血症住院患儿。主要暴露因素为低渗维持液的给药，主要结局为低钠血症（血清钠<135mEq/L）的发生。
共有 1048 例正常钠血症患儿在入院时接受低渗（n=674）或等渗（n=374）维持液。在接受低渗液的 260 例（38.6%）患儿和接受等渗液的 104 例（27.8%）患儿中发生低钠血症（未校正 OR 1.63；95%CI 1.24-2.15，P<.001）。在控制组间差异和潜在混杂因素后，接受低渗液的患者仍更有可能发生低钠血症（校正 OR 1.37，95%CI 1.03-1.84）。多变量分析确定了与低钠血症发生相关的其他因素，包括手术入院（校正 OR 1.44，95%CI 1.09-1.91）、心脏入院诊断（校正 OR 2.08，95%CI 1.34-3.20）和血液科/肿瘤科入院诊断（校正 OR 2.37，95%CI 1.74-3.25）。
无论维持液的渗透压如何，低钠血症都很常见；然而，与等渗液相比，低渗液的给药与发生医院获得性低钠血症的风险增加相关。其他临床特征改变了低渗液的低钠血症效应，现在可能需要更个体化的维持液治疗方法。
