Risks of severe hyponatremia in children receiving hypotonic fluids - 05/10/20
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Abstract |
Intravenous fluids are frequently used in hospitalized children. Hypotonic fluids have been the standard of care in pediatrics for many years. This might be explained by the empiricism of early recommendations favoring fluids with dextrose, but an insufficient amount of sodium. The risk of hyponatremia (<135mmol/L) might be increased by the occurrence of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in the course of common acute diseases (e.g., bronchiolitis, acute gastroenteritis, encephalitis, meningitis) in children. Severe hyponatremia (<130mmol/L) is often associated with neurologic complications leading to sequelae or even death. Over the last few years, hyponatremia induced by hypotonic fluids has been increasingly reported, and significant progress has been made in the understanding of cerebral edema and osmotic demyelination. Several randomized clinical trials have shown weak but significant evidence that isotonic fluids were superior to hypotonic solutions in preventing hyponatremia. However, clinical practices have not changed much in France, as suggested by the analysis of intravenous fluids ordered from the Assistance Publique–Hôpitaux de Paris (AP–HP) central pharmacy (PCH) in 2017. Therefore, it would be advisable that national guidelines be released under the French Health Authorities regarding the safe infusion of infants and children.
Le texte complet de cet article est disponible en PDF.Keywords : Children, Hypotonic fluids, SIADH, Cerebral edema, Osmotic demyelination
Plan
☆ | A conference of experts is expected to be organized in 2021 by the Service d’évaluation des bonnes pratiques professionnelles de la Haute Autorité de Santé with the participation of the following learned societies: Société Française de Pédiatrie, Groupe Francophone de Réanimation et d’Urgences Pédiatriques; Société Française de Médecine d’Urgence (SFMU); Société de Réanimation de Langue Française (SRLF); Société Française d’Anesthésie-Réanimation (SFAR); Association des Anesthésistes Réanimateurs Pédiatriques Français (ADARPEF). |
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