Electrolytes and Maintenance Intravenous (IV) Fluids

Background: Isotonic saline is the recommended standard treatment of choice for maintenance intravenous (IV) infusion in pediatric population (NEJM, Oct 2015) since the recognition of hyponatremia as a complication following hypotonic IV fluids. We studied the change in incidence of electrolyte abnormalities before and after the 2015 publication. We also determined the risk factors for the development of abnormal electrolytes and their associated morbidity and mortality. Methods: Data from the Integrated Data Repository (IDR) over a 10-yr period. Inclusion criteria: Children 2 months to 19 yrs who received IV fluids 24 hrs after admission from January 2012 to January 2022. Those with abnormal sodium levels on admission, patients with head trauma or stroke for whom hypernatremia was indicated, were excluded. SAS 9.4 version was used for statistical analysis. Results: We examined data from 104,911 patient hospital days in 5916 patients from two time periods 2012 to 2016 and 2017 to 2021. See Table on Demographics for more details. Sodium levels were done in 5,915 patients and the incidence of hypernatremia fell from 9% in 2012 to 16 to 7% in 2017 to 2021 (Chi Squared 115, P value <0.0001). The incidence of hyponatremia was the same in both year time periods (10%). The incidence of hyperkalemia was the same in both time periods (1%), but the incidence of significant hyperchloremia increased from 7% from 2012 to 2016 to 16% from 2017 to 2021 (p value <0.0001). The incidence of hypochloremia events fell from 5% from 2012 to 2016 to 3% from 2017 to 2021 (p value <0.0001). The incidence of both alkalosis and acidosis increased from the period of 2012-16 to 2017-21 from 8% to 11% (p value <0.0001) and 5% to 7% (p value <0.0001), respectively. Conclusion: Isotonic fluid use has not significantly changed the incidence of hyponatremia, but the incidence of hypernatremia has significantly decreased. We will discuss the incidence of a number of complications of maintenance IVF along with associated morbidity and mortality.