Aim To audit prescribing of intravenous fluids and monitoring of electrolytes against the National Patient Safety Agency (NPSA) guidelines and investigate the relationship between type of intravenous fluids and incidence of hyponatraemia. Administration of hypotonic intravenous fluids is a common practice in hospitalised children and can result in dangerous hyponatraemia (plasma sodium, PNa <130); commonest associations are sepsis, gastroenteritis and postsurgery. Children are known to be more susceptible to complications of hyponatraemic encephalopathy. NPSA recommends use of 0.9% NaCl if PNa ≤135 mmol/l.
Methodology Data were collected from all patients admitted with hyponatraemia between September 2007 and July 2009; their demography, underlying diagnosis, comorbidity, type of fluid prescribed initially and later and repeat blood results were analysed. The data were analysed using SPSS software (version 17.0) and manually using Excel spreadsheet.
Results There were 78 case entries with hyponatraemia (PNa <135) during our study period. The mean age was 5.9 years (range 0.1–16.0). Bloods were repeated in 45% of total patients'50% of Group 1 (PNa ≤130), 46% of Group 2 (PNa 131–133) and 42% of Group 3 (PNa >133). The numbers of times electrolytes were measured varied, with mean of 1.58, median 2.0 (range 0–4). Intravenous fluids were prescribed in 81% of Group 1, 51% of Group 2 and 70% of Group 3. 12.5% received 0.9% NaCl as maintenance fluids, of them 44% were Group 1. Among Group 1 36% received 0.9% Saline, 45% received 0.45% saline and 19% had oral fluids. While acute pneumonia and sepsis constituted 54% of Group 1 and 20% of total, gastroenteritis was 21% and postoperative patients 9% of the total. 45% of Group 1 and 29% of Group 3 had a comorbid condition.
Conclusion The practice of intravenous fluid prescribing for maintenance and ongoing losses, coupled with monitoring of serum electrolytes during the study period did not meet the recommended standards of NPSA guidance published in March 2007. New guidelines have now been in effect since July 2009. We recommend a prospective audit with strict adherence to the guidelines to avoid possible disastrous consequences and ensure uniformity of practice.
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