Suat BİÇER, ESRA ŞEVKETOĞLU, Metin KARABÖCÜOĞLU

Çocuklarda hangi parenteral idame sıvıları kullanılmalı?

İdame sıvı tedavisi uygulanan hastalarda en sık gelişen elektrolit bozukluğu hiponatremidir. İntravenöz tedavide kullanılan sıvıların hacmi ve içeriği akut hiponatremi gelişmesine katkıda bulunur. Hastanede hiponatremi gelişimi için en önemli faktör hipotonik intravenöz sıvıların kullanılmasıdır. Çocuklarda kullanılan idame sıvılarındaki fazla miktarda serbest su hiponatremi gelişmesini kolaylaştırabilir. Hipotonik idame sıvıları antidiüretik hormon üretiminin fazla olduğu vakalarda fatal hiponatremiye neden olabilir. İzotonik ya da az hipotonik idame sıvılarının uygulanması, parenteral sıvı alan çocuklarda, hiponatremi sıklığını azaltabilir. Anahtar kelimeler: Hiponatremi, parenteral sıvı, antidiüretik hormon, idame sıvısı

Anahtar Kelimeler:

Vazopressinler, Çocuk, Hiponatremi, Parenteral beslenme, Su-elektrolit dengesizliği

Which maintenance parenteral fluids should be used in children?

Hyponatremia is the most common electrolyte abnormality in patients who are given parenterally maintenance fluid. The volume and composition of fluids used for intravenous therapy often contribute to the development of acute hyponatremia. The most important factor for hospital acquired hyponatremia is the administration of hypotonic intravenous fluids. Commonly used intravenous fluids have a significant amount of free water that can contribute to hyponatremia. Hypotonic maintenance fluids can lead to potentially fatal hyponatremia in cases of excess antidiuretic hormone production. The administration of isotonic or less hypotonic maintenance fluids may decrease the frequency of hyponatremia in children who are receiving parenteral fluids.

Keywords:

Vasopressins, Child, Hyponatremia, Parenteral Nutrition, Water-Electrolyte Imbalance,

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1. Chesney RW. The maintenance need for water in parenteral fluid therapy. Pediatrics 1998; 102:399-400.
2. Holliday MA, Segar WE. The maintenance need for water in parenteral fluid therapy. Pediatrics. 1957; 19:823-32.
3. Moritz ML, Ayus JC. Prevention of hospital acquired hyponatremia: a case for using isotonic saline in maintenance fluid therapy. Pediatrics 2003; 111:227-30.
4. Larry A. Greenbaum. Pathophysiology of Body Fluids and Fluid Therapy. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics, 17th ed. Philadelphia, WB. Saunders Co, 2004:191-251.
5. Arieff AI, Ayus JC, Fraser CL. Hyponatremia and death or permanent brain damage in healthy children. BMJ 1992; 304:1218-22.
6. Holliday MA, Segar WE, Friedman A. Reducing errors in fluid therapy management. Pediatrics 2003; 111:424-5.
7. Darrow DC, Pratt EL. Fluid therapy, relation to tissue composition and expenditure of water and electrolyte. Council on Food and Nutrition. JAMA 1950; 143:432-39.
8. Anderson RJ. Hospital-associated hyponatremia. Kidney Int 1986; 29:1237-47.
9. Kennedy PG, Mitchell DM, Hoffbrand BI. Severe hyponatremia in hospital inpatients. BMJ 1978; 2:1251-3.
10. Fraser CL, Arieff AI. Epidemiology, pathophysiology and management of hyponatremic encephalopathy. Am J Med 1997; 102: 67-77.
11. Shafîee MA, Bohn D, Hoorn EJ, Halperin ML. How to select optimal maintenance intravenous fluid therapy. QJM 2003; 96:601-10.
12. Sterns RH, Silver SM, Spital A. Hyponatremia. In: Seldin DW, Giebisch G, eds. The Kidney: Physiology&Pathophysiology. Philadelphia PA, Lippincott. Williams&Wilkins, 2000:1217-38.
13. Halberthal M, Halperin ML, Bohn D. Acute hyponatremia in children admitted to hospital: retrospective analysis of factors contributing to its development and resolution. BMJ 2001; 322:780-2.
14. Hoorn EJ, Geary D, Robb M, Halperin ML, Bohn D. Acute hyponatremia related to intravenous fluid administration in hospitalized children: An observational study. Pediatrics 2004; 113:1279-84.
15. Talbot NB, Crawford DJ, Butler AM. Medical progress: homeostatic limits to safe parenteral fluid therapy. N Engl J Med 1953; 248:1100-8.
16. Karabocuoglu M, Soysal D, Nayir A, Türkoğlu U, Citak A, Ucsel R, Uzel N. Maintenance fluid contain at least 77 mmol sodium per liter for critically ill pediatric patients. 26th International Symposium on Intensive Care and Emergency Medicine, March 21-24, Brussels, Belgium. Crit Care 2006, 10(Suppl 1): P 181.
17. Wattad A, Chiang ML, Hill LL. Hyponatremia in hospitalized children. Clin Pediatr 1992; 31:153-57.
18. Gregorio L, Sutton CL, Lee DA. Central pontine myelinolysis in a previously healthy 4-year-old child with acute rotavirus gastroenteritis. Pediatrics 1997; 99:738-43.
19. Burrows FA, Shutack JG, Crone RK. Inappropriate secretion of antidiuretic hormone in a postsurgical pediatric population. Crit Care Med 1983; 11:527-31.
20. Goldberg M. Hyponatremia. Med Clin North Am 1981; 65:251-69.
21. Rose BD. New approach to disturbances in the plasma sodiurn concentration. Am J Med 1986; 81:1033-40.
22. Bohn D, Hoorn E, Halperin ML. Hospital-Acquired Hyponatremia Is Associated With Excessive Administration of Intravenous Maintenance Fluid: In Reply. Pediatrics 2004; 114:1744-5.
23. Hatherill M, Waggie Z, Salie S, Argent A. Hospital-Acquired Hyponatremia Is Associated With Excessive Administration of Intravenous Maintenance Fluid. Pediatrics 2004;114:1368.
24. Hatherill M. Rubbing salt in the wound. Arch Dis Child 2004; 89:414-18.
25. Pearson GA. Fluid, electrolyte and acid-base disturbances. In: Mclntosch N, Helms PJ, Smyth RL (eds). Forfar&Arneil's Textbook of Pediatrics. Sixth edition, Edinburgh, Churchill Livingstone, 2003: 583-93.