The effect of NaCl 0.9% and NaCl 0.45% on sodium, chloride, and acid-base balance in a PICU population

• Main Authors: Helena Isabel Almeida, Maria Inês Mascarenhas, Helena Cristina Loureiro, Clara S. Abadesso, Pedro S. Nunes, Marta S. Moniz, Maria Céu Machado
• Format: Article
• Language: English
• Published: Elsevier 2015-10-01
• Series: Jornal de Pediatria
• Subjects: Equilíbrio ácido-base; Cloreto; Hiponatremia; Fluidos de manutenção; Pediatria; Sódio
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0021-75572015000500499&lng=en&tlng=en

ABSTRACT OBJECTIVES: To study the effect of two intravenous maintenance fluids on plasma sodium (Na), and acid-base balance in pediatric intensive care patients during the first 24 h of hospitalization. METHODS: A prospective randomized controlled study was performed, which allocated 233 patients to groups: (A) NaCl 0.9% or (B) NaCl 0.45%. Patients were aged 1 day to 18 years, had normal electrolyte concentrations, and suffered an acute insult (medical/surgical). Main outcome measured: change in plasma sodium. Parametric tests: t-tests, ANOVA, X 2 statistical significance level was set at a = 0.05. RESULTS: Group A (n = 130): serum Na increased by 2.91 (±3.9) mmol/L at 24 h (p < 0.01); 2% patients had Na higher than 150 mmol/L. Mean urinary Na: 106.6 (±56.8) mmol/L. No change in pH at 0 and 24 h. Group B (n = 103): serum Na did not display statistically significant changes. Fifteen percent of the patients had Na < 135 mmol/L at 24 h. The two fluids had different effects on respiratory and post-operative situations. CONCLUSIONS: The use of saline 0.9% was associated with a lower incidence of electrolyte disturbances.