Using saline solutions for ACE washouts
Sarah-Jane Hyde 1, Malcolm G Coulthard 1*, Bruce Jaffray 1, Mary E Vallely 1 and Sally M Harding 1
1 Royal Victoria Infirmary, United Kingdom
* To whom correspondence should be addressed. E-mail: malcolm.coulthard{at}nuth.nhs.uk.
Accepted 16 September 2007
 | Abstract |
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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 minutes, and falls in urine sodium and osmolality. With 2NS, the plasma sodium rose by 2.5 mmol/l and the plasma proteins rose by 2.3 g/l, 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.
Keywords:
antegrade colonic enema, hypernatraemia, hyponatraemia, lavage fluid
