bachelorThesis
Riesgo de hiponatremia con soluciones de mantenimiento en niños críticos en la Fundación Cardioinfantil entre 2015-2018
Autor
Pérez Munévar, Andrea Margarita
Echeverri Álvarez, Maria Alejandra
Institución
Resumen
Introduction: There is an association between the use of hypotonic solutions and hyponatremia, however they are still used in intensive care where patients have additional risk factors to present it. Our objective was to evaluate the association of acute hyponatremia in critically ill children with the type of maintenance solution. Materials and methods: Retrospective cohort-type analytical observational study in children in intensive care between 2015-2018, who received maintenance fluids in the first 48 hours after admission. Univariate, bivariate and multivariate analyzes were performed, controlling for confounding factors. P <0.05 was considered significant. Results: 1668 patients were included, 503 met the inclusion criteria. 24.1% presented hyponatremia, being more frequent in those who received hypotonic solutions (37% vs 63%, comparative OR 1.41 95% CI 0.92, 2.15 p = 0.106) with an increase in hospital stay (Difference of means 8 , 95% CI 2.67, 13.3, p = 0.001). The use of ASA diuretics and postoperative patients had a higher risk of hyponatremia if they received hypotonic solutions. (OR 2.1 95% CI 1.41, 3.0 p = 0.000). Balanced isotonic solutions had a lower risk of developing hyponatremia (OR 0.59 95% CI 0.35, 0.99, p = 0.007) and hyperchloremia (OR 0.51 95% CI 0.34, 0.77, p = 0.000) . Conclusion: 1 in 4 children who received maintenance fluids had acute hyponatraemia; being more frequent with hypotonic solutions, in postoperative patients who received loop diuretic, increasing the length of hospital stay. Clinical trials are required to establish the most effective and safe maintenance solution in critically ill children.