2023 – Höstens artikel

2023-09-22 14:32:52
2023-09-22 14:47:47
Christiane Garnemark

Risk of Electrolyte Disorders in Acutely Ill Children Receiving Commercially Available Plasmalike Isotonic Fluids: A Randomized Clinical Trial – PubMed (nih.gov)

PMID: 33104176 PMCID: PMC7589076 DOI: 10.1001/jamapediatrics.2020.3383

Importance: The use of isotonic fluid therapy is currently recommended in children, but there is limited evidence of optimal fluid therapy in acutely ill children.

Objective: To evaluate the risk for electrolyte disorders, including hyponatremia, hypernatremia, and hypokalemia, and the risk of fluid retention in acutely ill children receiving commercially available plasmalike isotonic fluid therapy.

Interventions: Acutely ill children were randomized to receive commercially available plasmalike isotonic fluid therapy (140 mmol/L of sodium and 5 mmol/L potassium in 5% dextrose) or moderately hypotonic fluid therapy (80 mmol/L sodium and 20 mmol/L potassium in 5% dextrose).

Main outcomes and measures:
The primary outcome was the proportion of children with any clinically significant electrolyte disorder, defined as hypokalemia less than 3.5 mmol/L, hypernatremia greater than 148 mmol/L, or hyponatremia less than 132 mmol/L during hospitalization due to acute illness.
The main secondary outcomes were the proportion of children with severe hypokalemia and weight change.

Conclusions and relevance: In this randomized clinical trial, commercially available plasmalike isotonic fluid therapy markedly increased the risk for clinically significant electrolyte disorders, mostly due to hypokalemia, in acutely ill children
compared with previously widely used moderately hypotonic fluid therapy containing 20 mmol/L of potassium.

Trial registration: ClinicalTrials.gov identifier: NCT02926989.

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