Andrea Scioscia, MD
Children's Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania
Disclosure information not submitted.
.jpeg.jpg "Jonathan Pelletier, MD photo")
Jonathan Pelletier, MD
Clinical Instructor
Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania
Disclosure information not submitted.
Christopher Horvat, MD, MHA
Children's Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania
Disclosure information not submitted.
Dana Fuhrman, DO, MS
Children's Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania
Disclosure information not submitted.
Title: THE IMPACT OF MAINTENANCE FLUIDS ON THE DEVELOPMENT OF HYPERCHLOREMIA IN PEDIATRIC ICU PATIENTS
Introduction: Volume resuscitation with normal saline (0.9% sodium chloride) has been previously shown to be associated with hyperchloremic metabolic acidosis, acute kidney injury, and in-hospital mortality. Despite this, its use as a maintenance fluid is currently endorsed by the American Academy of Pediatrics. It is unknown, however, whether balanced electrolyte maintenance fluids reduce hyperchloremia compared to normal saline (NS).
Methods: In this retrospective cohort study, we included all patients > 20 kg admitted with critical asthma to the pediatric intensive care unit (PICU) at our quaternary children’s hospital from 2015 through 2019. We stratified patients by the type of maintenance fluid administered (NS vs. balanced fluids: Lactated Ringer’s, or Plasma-Lyte). We used a linear regression model to compare the differences in chloride and bicarbonate levels within the first 72 hours of admission based on the volume and type of maintenance fluid received.
Results: There were 1,443 patients in the cohort. The starting mean chloride level did not differ between the two groups (NS: 107.98 ± 4.87 mMol/L, Balanced: 108.28 ± 4.15 mMol/L, p=0.161). Patients who received NS maintenance fluids demonstrated a greater increase in chloride level in the first 72 hours of admission compared to patients who received balanced solutions. Every 10 ml/kg of NS was associated with a 0.21 mMol/L increase in serum chloride (r2= 0.04, p< 0.01). Patients who received balanced solutions trended toward a decrease in their serum chloride, though not statistically significant (every 10ml/kg of balanced solution associated with 0.10 mMol/L decrease in serum chloride, r2= 0.011, p=0.11). For patients receiving NS, there was also a trend toward a decrease in serum bicarbonate levels, though again this was not statistically significant (every 10 ml/kg of NS associated with 0.05 mMol/L decrease, r2= 0.004, p=0.128).
Conclusions: The results of this study indicate that balanced solutions may be more favorable over normal saline as maintenance fluids for patients admitted to the PICU with critical asthma, due to their decreased propensity for hyperchloremia. Further work should be done to evaluate the impact of this hyperchloremia on sequelae, such as acute kidney injury or worsening tachypnea.