How much salt is sufficient?

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How much salt is sufficient?

Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 9, Issue 3

Abstract

Most of the guidelines and textbooks are still recommending hypotonic maintenance fluids for pediatric patients based on Holliday-Segar method. Maintenance intravenous (IV) fluids are designed to maintain homeostasis. There is risk of iatrogenic hyponatremia with hypotonic intravenous (IV) maintenance in otherwise normal children. Administration of hypotonic IV fluids is a major risk factor for developing hyponatremia in hospitalized euvolemic children who are dependent upon parenteral fluid therapy. The risk will increase significantly in those with the risk of Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH). The estimated incidence of clinically significant, symptomatic cases of hospital acquired acute hyponatremia is relatively low (0.07%). Severe hyponatremia (<120 mmol/l) has been reported to be associated with increase in the cost of stay, morbidity and mortality. Hyponatremia is common in patients with infection (especially severe infection) and pulmonary disease (hypoxemic state). Hyponatremia has been reported in 52% of children with febrile convulsions and 33% of children with Respiratory syncytial virus (RSV) bronchiolitis. Surgical patients tended to have a greater fall in plasma sodium level than nonsurgical patients. Antidiuretic hormone (ADH) concentrations increase 2-4 folds during the operation and remained elevated through the first 24 hours postoperatively. There is increased risk of hyponatremia in postoperative children randomly assigned to hypotonic solution compared with those who received isotonic solution. There was no significant difference in the sodium level between ventilated and non-ventilated patients. So, what to do in case the SIADH is possible? Is it right to increase the salt concentration or decrease the rate of the fluid? It was found that the fluid type (isotonic or hypotonic solutions), not rate, determined the risk of hyponatremia and serum sodium changes, and fluid restriction may not satisfy a child’s daily requirement. There is no evidence supports decrease the fluid rate to prevent hyponatremia due to increase SIADH. Isotonic fluids are safer than hypotonic fluids in hospitalized children requiring maintenance IV fluid therapy in terms of plasma sodium level. Any child in hospital who requires IV fluids should be considered at risk for developing hyponatremia due to increased risk of SIADH. At particular risk are: Children undergoing surgery, Children with acute neurological or respiratory infections (eg, meningitis, encephalitis, pneumonia and bronchiolitis). So why not to use the isotonic fluid (Dextrose 5% in 0.9% Sodium Chloride) as maintenance for all patients? There is potential risk for hypernatremia with salt and water overload. There are also risks of developing hyperchloremic metabolic acidosis has been recognized in the context of rapid isotonic saline infusion, in addition to the increase in the serum osmolarity.

Authors and Affiliations

Amar Al Shibli

Keywords

Amar Al Shibli Hyponatremia Bronchiolitis Esssncephalitis Pneumonia Meningitisss Antidiuretic hormone Encephalitis Intravenous fluid therapy Isotonic saline SIADH Electrolytes

EP ID EP591777
DOI 10.26717/BJSTR.2018.09.001817
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