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The use of hypotonic fluids in paediatric practice
  1. J Baker1,
  2. K Armon2,
  3. S Playfor3,
  4. O Rackham1
  1. 1Paediatrics, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
  2. 2Paediatrics, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
  3. 3Paediatric Intensive Care, Royal Manchester Children's Hospital, Manchester, UK

Abstract

Background The use of hypotonic intravenous fluids in children has been associated with significant electrolytes abnormalities. In particular, 0.18% sodium chloride with 4% glucose has been linked with hyponatraemia, even death. In 2004, Armon et al1 conducted an audit describing the types of fluid prescribed in paediatric wards. This concluded that most children received hypotonic fluids, electrolyte abnormalities were common and that few units (30%) had guidelines for prescribing intravenous fluids. In 2007 the National Patient Safety Agency (NPSA) published advice on administering intravenous fluids in children. This recommended removing 0.18% sodium chloride with 4% glucose from ‘general’ ward areas.

To describe

  • the types of fluids used in paediatric wards following the NPSA alert,

  • the frequency of electrolyte disturbance,

  • the number of units with guidelines for prescribing fluids.

Method A prospective multicentre ‘snapshot’ audit. Centres that had participated in the original audit and all members of the Paediatric Research Society were invited to participate. Data were collected using a standard proforma. All patients on paediatric wards (excluding neonatal units) were eligible.

Results Results were received from 36 hospitals, for 234 patients. Most (60%) were ‘general paediatric’ patients, while 32% were under surgical care. The commonest reasons for intravenous fluid administration were ‘nil by mouth’ (39%), decreased intake (30%) and rehydration (17%). Hypotonic fluids were given to 116 children (of which 93 received 0.45% sodium chloride with 5% glucose). Isotonic fluids were prescribed for 112 children. No patients received 0.18% sodium chloride with 4%glucose. 30 patients had not had electrolytes checked since starting intravenous fluids. Hyponatraemia was found in 20 patients, 12 of which received hypotonic fluids. Hypernatraemia was found in 13 patients, 8 of which received hypotonic fluids. Of the 36 hospitals, 28 had guidelines for prescribing intravenous fluids.

Conclusion In a ‘snapshot’ survey of 36 hospitals across the UK, paediatric patients are no longer receiving 0.18% sodium chloride with 4% glucose, in line with the NPSA alert. However, half of the patients received hypotonic fluids; most commonly 0.45% sodium chloride with 5% glucose. More units have guidelines for prescribing intravenous fluids, but in a quarter of units junior doctors still prescribe intravenous fluids without clear guidelines.

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