Aims:To determine whether the risk of hyponatraemia in children with gastroenteritis receiving intravenous(IV)fluids is decreased by the use of 0.9%saline.Methods:A prospective randomised study was carried out in a te...Aims:To determine whether the risk of hyponatraemia in children with gastroenteritis receiving intravenous(IV)fluids is decreased by the use of 0.9%saline.Methods:A prospective randomised study was carried out in a tertiary paediatric hospital.A total of 102 children with gastroenteritis were randomised to receive either 0.9%saline +2.5%dextrose(NS)or 0.45%saline +2.5%dextrose(N/2)at a rate determined by their treating physician according to hospital guidelines and clinical judgement.Plasma electrolytes,osmolality,and plasma glucose were measured before(T0)and 4 hours after(T4)starting IV fluids,and subsequently if clinically indicated.Electrolytes and osmolality were measured in urine samples.Results were analysed according to whether children were hyponatraemic(plasma sodium < 135 mmol/l)or normonatraemic at T0.Results:At T0,mean(SD)plasma sodium was 135(3.3)mmol/l(range 124-142),with 37/102(36%)hyponatraemic.At T4,mean plasma sodium in children receiving N/2 remained unchanged in those initially hyponatraemic(n = 16),but fell 2.3(2.2)mmol/l in the normonatraemic group.In contrast,among children receiving NS,mean plasma sodium was 2.4(2.0)-mmol/l higher in those hyponatraemic at baseline(n = 21)and unchanged in the initially normonatraemic children.In 16 children who were still receiving IV fluids at 24 hours,3/8 receiving N/2 were hyponatraemic compared with 0/8 receiving NS.No child became hypernatraemic.Conclusions:In gastroenteritis treated with intravenous fluids,normal saline is preferable to hypotonic saline because it protects against hyponatraemia without causing hypernatraemia.展开更多
文摘Aims:To determine whether the risk of hyponatraemia in children with gastroenteritis receiving intravenous(IV)fluids is decreased by the use of 0.9%saline.Methods:A prospective randomised study was carried out in a tertiary paediatric hospital.A total of 102 children with gastroenteritis were randomised to receive either 0.9%saline +2.5%dextrose(NS)or 0.45%saline +2.5%dextrose(N/2)at a rate determined by their treating physician according to hospital guidelines and clinical judgement.Plasma electrolytes,osmolality,and plasma glucose were measured before(T0)and 4 hours after(T4)starting IV fluids,and subsequently if clinically indicated.Electrolytes and osmolality were measured in urine samples.Results were analysed according to whether children were hyponatraemic(plasma sodium < 135 mmol/l)or normonatraemic at T0.Results:At T0,mean(SD)plasma sodium was 135(3.3)mmol/l(range 124-142),with 37/102(36%)hyponatraemic.At T4,mean plasma sodium in children receiving N/2 remained unchanged in those initially hyponatraemic(n = 16),but fell 2.3(2.2)mmol/l in the normonatraemic group.In contrast,among children receiving NS,mean plasma sodium was 2.4(2.0)-mmol/l higher in those hyponatraemic at baseline(n = 21)and unchanged in the initially normonatraemic children.In 16 children who were still receiving IV fluids at 24 hours,3/8 receiving N/2 were hyponatraemic compared with 0/8 receiving NS.No child became hypernatraemic.Conclusions:In gastroenteritis treated with intravenous fluids,normal saline is preferable to hypotonic saline because it protects against hyponatraemia without causing hypernatraemia.
