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Using saline solutions for ACE washouts
  1. Sarah-Jane Hyde (s.j.m.hyde{at}ncl.ac.uk)
  1. Royal Victoria Infirmary, United Kingdom
    1. Malcolm G Coulthard (malcolm.coulthard{at}nuth.nhs.uk)
    1. Royal Victoria Infirmary, United Kingdom
      1. Bruce Jaffray (bruce.jaffray{at}nuth.nhs.uk)
      1. Royal Victoria Infirmary, United Kingdom
        1. Mary E Vallely (mary.vallely{at}nuth.nhs.uk)
        1. Royal Victoria Infirmary, United Kingdom
          1. Sally M Harding (sally.harding{at}nuth.nhs.uk)
          1. Royal Victoria Infirmary, United Kingdom

            Abstract

            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.

            • antegrade colonic enema
            • hypernatraemia
            • hyponatraemia
            • lavage fluid

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