Austin Weiss, MD,
Fellow, Pediatric Critical Care Medicine
Rady Children's Hospital - San Diego
San Diego, California
Disclosure information not submitted.
Helen Harvey, MD, MS
Fellowship Program Director
Rady Children's Hospital - San Diego, United States
Disclosure information not submitted.
Jennifer Foley, RN, BSN
Clinical Research Coordinator, Pediatric Critical Care
UC San Diego / Rady Children's Hospital San Diego, United States
Disclosure information not submitted.
Nicole Coufal, MD, PhD
Attending Physician, Assistant Professor
University of California - San Diego, Rady Children's Hospital, United States
Disclosure information not submitted.
Title: Hyperchloremia and AKI in Pediatric Patients with TBI Treated with Hypertonic Saline Infusion
Introduction: Hyperchloremia is associated with acute kidney injury (AKI) and increased mortality in critically ill adults, but it is unknown if a similar association exists among critically ill children. The aim of this study is to determine the incidence of hyperchloremia and its association with AKI and mortality in pediatric patients with traumatic brain injury (TBI) receiving continuous infusion of hypertonic saline (HTS).
Methods: We conducted a single center retrospective review at a tertiary pediatric hospital from January 2014 to 2020. 136 pediatric patients met inclusion criteria; all patients with TBI who received continuous infusions of HTS. The development of AKI was defined by the Kidney Disease Improving Global Outcomes (KDIGO) consensus criteria. Hyperchloremia was defined as a serum concentration ≥110 mmol/L. Outcomes included incidence and severity of AKI, admission renal function, and length and severity of hyperchloremia.
Results: The average duration of HTS infusion was 4.3 days (IQR: 2-7). The average GCS at presentation was 10 (IQR: 6-14). 54 patients (39.7%) had an EVD or ICP monitor placed. 51 patients (37.5%) remained intubated on day 7 of admission. 34 patients (25%) had a vasoactive requirement on day 7 of admission. 118 patients (86.8%) developed hyperchloremia with [Cl-]max ≥110 mmol/L. 103 patients (75.7%) were persistently hyperchloremic with [Cl-]mean ≥110 mmol/L. 13 patients (9.6%) developed AKI per KDIGO criteria, with 5 patients (3.7%) stage 2 or higher. One patient (0.7%) required hemodialysis. Overall 28 day mortality was (5.1%).
Conclusions: Hyperchloremia is common in pediatric patients with TBI receiving continuous infusion of HTS. The development of AKI and 28-day mortality in this patient population is uncommon.