Grisaru Silviu, Xie Jianling, Samuel Susan, Freedman Stephen B
Section of Pediatric Nephrology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Section of Pediatric Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Front Pediatr. 2017 Oct 6;5:210. doi: 10.3389/fped.2017.00210. eCollection 2017.
Acute gastroenteritis (AGE) causing dehydration with or without dysnatremias is a common childhood health challenge. While it is accepted that oral rehydration therapy is preferred, clinical factors or parent and healthcare provider preferences may lead to intravenous rehydration (IVR). Isotonic solutions are increasingly recommended in most scenarios requiring IVR. Nevertheless, children with AGE, having ongoing losses of water and electrolytes, represent a unique population.
To evaluate the association between acquired dysnatremias and IVR in children with AGE.
A systematic search of MEDLINE database was conducted through September 14, 2016. Observational studies and clinical trials conducted in high-income countries were included. The Grades of Recommendation, Assessment, Development, and Evaluation approach was used to evaluate the overall quality of evidence for each outcome.
603 papers were identified of which 6 were included (3 randomized controlled trials and 3 observational studies). Pooling of patient data was not possible due to significantly different interventions or exposures. Single studies results demonstrated that within 24 h, administration of isotonic saline was not associated with a significant decline in serum sodium while hypotonic solutions (0.2-0.45% saline) were associated, in one study, with mean serum sodium declines from 1.3 mEq/L (139.2, SD 2.9-137.9, SD 2.5) in 133 young infants (aged 1-28 months), to 5.7 (SD 3.1) mEq/L in a subgroup of 18 older children (age mean 5.8, SD 2.7 years). Both isotonic and hypotonic saline were shown to be associated with improvement of baseline hyponatremia in different studies. Baseline hypernatremia was corrected within 4-24 h in 81/83 (99.6%) children using hypotonic saline IVR.
There is a paucity of publications assessing the risk for acquired dysnatremias associated with IVR in children with AGE. Current high-quality evidence suggests that, short-term use of isotonic solutions is safe and effective in most children with AGE; hypotonic solutions may also be appropriate in some subpopulations, however, the quality of available evidence is low to very low. Further research investigating outcomes associated with IVR use beyond 24 h focusing on specific age groups is required.
急性肠胃炎（AGE）导致脱水伴或不伴有电解质紊乱是儿童常见的健康挑战。虽然公认口服补液疗法是首选，但临床因素或家长及医疗服务提供者的偏好可能导致静脉补液（IVR）。在大多数需要静脉补液的情况下，越来越推荐使用等渗溶液。然而，患有AGE且持续丢失水和电解质的儿童是一个特殊群体。
评估AGE患儿获得性电解质紊乱与静脉补液之间的关联。
对MEDLINE数据库进行系统检索，截至2016年9月14日。纳入在高收入国家进行的观察性研究和临床试验。采用推荐分级、评估、制定和评价方法来评估每个结局的证据总体质量。
共识别出603篇论文，其中6篇被纳入（3项随机对照试验和3项观察性研究）。由于干预措施或暴露情况存在显著差异，无法汇总患者数据。单项研究结果表明，在24小时内，一项研究中，给予等渗盐水与血清钠显著下降无关，而低渗溶液（0.2 - 0.45%盐水）与血清钠下降有关，133名1 - 28个月的幼儿血清钠平均从1.3 mEq/L（139.2，标准差2.9 - 137.9，标准差2.5）降至18名年龄稍大儿童（平均年龄5.8岁，标准差2.7岁）亚组中的5.7（标准差3.1）mEq/L。在不同研究中，等渗和低渗盐水均显示与基线低钠血症的改善有关。使用低渗盐水静脉补液，81/83（99.6%）的儿童在4 - 24小时内纠正了基线高钠血症。
评估AGE患儿静脉补液相关获得性电解质紊乱风险的出版物较少。目前的高质量证据表明，大多数AGE患儿短期使用等渗溶液是安全有效的；低渗溶液在某些亚组中可能也适用，然而，现有证据的质量很低至极低。需要进一步研究关注特定年龄组超过24小时使用静脉补液的结局。
