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Using saline solutions for ACE washouts

¹ Medical School, Newcastle University, Newcastle, UK
² Department of Paediatric Nephrology, Royal Victoria Infirmary, Newcastle, UK
³ Department of Paediatric Surgery, Royal Victoria Infirmary, Newcastle, UK

Correspondence to:
Dr Malcolm G Coulthard, Department of Paediatric Nephrology, Royal Victoria Infirmary, Newcastle NE2 2RE, UK; malcolm.coulthard{at}nuth.nhs.uk

We had found that twice-normal saline (2NS) antegrade continence enema (ACE) lavages were better than with normal saline (NS) but caused unpleasant symptoms. We therefore undertook a double-blind crossover study comparing water, NS and 2NS in four children. NS produced no disturbances, but water caused a transient fall in plasma osmolality of 7.3 mosmol/kg at 20 min, and falls in urine sodium and osmolality. With 2NS, the plasma sodium rose by 2.5 mmol/l, the plasma proteins rose by 2.3 g/l and the lavage fluid sodium fell, suggesting that about 10 ml/kg of plasma water had moved into the colonic lumen, and two subjects became thirsty. Five other children did home testing. Their home-produced saline was too concentrated and varied widely, and they found that 30 ml/kg of NS produced the same washout result as 20 ml/kg of 2NS. Carefully made-up NS should be used for lavage, increasing volumes if necessary.