Electrolyte derangements in critically ill children receiving balanced versus unbalanced crystalloid fluid resuscitation.

Natalja L Stanski, Katja M Gist, Kaci Pickett, John T Brinton, Jennifer Sadlowski, Hector R Wong, Peter Mourani, Danielle E Soranno, Jessica Kendrick, Erin K Stenson

Journal: BMC nephrology 2022;23(1):388

PMID: 36474179

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Abstract

BACKGROUND

Adult studies have demonstrated potential harm from resuscitation with 0.9% sodium chloride (0.9%NaCl), resulting in increased utilization of balanced crystalloids like lactated ringers (LR). The sodium and potassium content of LR has resulted in theoretical safety concerns, although limited data exists in pediatrics. We hypothesized that use of LR for resuscitation would not be associated with increased electrolyte derangements compared to 0.9%NaCl.

METHODS

A prospective, observational cohort study of critically ill children who received ≥ 20 ml/kg of fluid resuscitation and were admitted to two pediatric intensive care units from November 2017 to February 2020. Fluid groups included patients who received > 75% of fluids from 0.9%NaCl, > 75% of fluids from LR, and a mixed group. The primary outcome was incidence of electrolyte derangements (sodium, chloride, potassium) and acidosis.

RESULTS

Among 559 patients, 297 (53%) received predominantly 0.9%NaCl, 74 (13%) received predominantly LR, and 188 (34%) received a mixture. Extreme hyperkalemia (potassium ≥ 6 mmol/L) was more common in 0.9%NaCl group (5.8%) compared to LR group (0%), p 0.05. Extreme acidosis (pH > 7.1) was more common in 0.9%NaCl group (11%) compared to LR group (1.6%), p 0.016.

CONCLUSIONS

LR is associated with fewer electrolyte derangements compared to 0.9%NaCl. Prospective interventional trials are needed to validate these findings.

Address: Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.; Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.; Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.; Research Informatics, Children's Hospital Colorado, Aurora, CO, USA.; Department of Pediatrics, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, USA.; Division of Critical Care Medicine, Arkansas Children's Hospital, Little Rock, AR, USA.; Section of Nephrology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.; Division of Renal Disease and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA. [email protected].; Section of Critical Care, University of Colorado School of Medicine and Children's Hospital Colorado, 13121 E 17th Avenue, MS8414, Aurora, CO, 80045, USA. [email protected].

DOI: 10.1186/s12882-022-03009-w

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MeSH Terms: Humans, Child, Crystalloid Solutions, Prospective Studies, Research Design, Sodium, Potassium