Use of plasmalike isotonic fluids may be harmful for acutely ill children: JAMA

Finland: The use of commercially available plasmalike isotonic fluids for fluid therapy in acutely ill children increases the risk for electrolyte disorders, mostly due to hypokalemia, suggests a recent study. The findings of the study, published in the journal JAMA Pediatrics, suggest that the isotonic fluids without potassium are not optimal for fluid therapy in acutely ill children.

Currently, the use of isotonic fluid therapy is recommended in children but there is not much evidence of optimal fluid therapy in acutely ill children. Considering the same, Saara Lehtiranta, Oulu University Hospital, Oulu, Finland, and colleagues evaluated the risk for electrolyte disorders including hypokalemia, hypernatremia, and hyponatremia, and the risk of fluid retention in acutely ill children receiving commercially available plasmalike isotonic fluid therapy.

This unblinded, randomized clinical pragmatic trial included 614 subjects (aged 6 months to 12 years of age) who required hospitalization due to an acute illness, and needed IV fluid therapy. Subjects with following parameters were excluded; those with plasma sodium concentration of less than 130 mmol/L or greater than 150 mmol/L on admission, a plasma potassium concentration of less than 3.0 mmol/L on admission; clinical need of fluid therapy with 10% glucose solution; a history of diabetes, diabetic ketoacidosis, or diabetes insipidus; a need for renal replacement therapy; severe liver disease; pediatric cancer requiring protocol-determined chemotherapy hydration; and inborn errors of metabolism.

All outcomes and samples size were prespecified except those clearly marked as exploratory post hoc analyses. All analyses were intention to treat.

The included children were randomized to receive commercially available plasmalike isotonic fluid therapy (140 mmol/L of sodium and 5 mmol/L potassium in 5% dextrose) or moderately hypotonic fluid therapy (80 mmol/L sodium and 20 mmol/L potassium in 5% dextrose).

The primary outcome was the proportion of children with any clinically significant electrolyte disorder, defined as hypokalemia less than 3.5 mmol/L, hypernatremia greater than 148 mmol/L, or hyponatremia less than 132 mmol/L during hospitalization due to acute illness.  

"In this randomized clinical trial, commercially available plasmalike isotonic fluid therapy markedly increased the risk for clinically significant electrolyte disorders, mostly due to hypokalemia, in acutely ill children compared with previously widely used moderately hypotonic fluid therapy containing 20 mmol/L of potassium," wrote the authors. 

"Risk of Electrolyte Disorders in Acutely Ill Children Receiving Commercially Available Plasmalike Isotonic Fluids: A Randomized Clinical Trial," is published in the journal JAMA Pediatrics.

DOI: https://jamanetwork.com/journals/jamapediatrics/article-abstract/2772182