Why is ns 0.9

Patients aged 1 day to 18 years old were included, with an acute insult medical or surgical , who needed exclusive administration of intravenous fluids for more than 24 h.

During the study, patients in whom the maintenance fluid was switched or interrupted before 24 h were excluded. In both arms of the study, fluid volume protocols were the same.

During this study, every fluid ressuscitation was done with NaCl 0. A daily water balance of zero was aimed in this set of patients, and diuretic furosemide , when needed, was administered to achieve this goal. This study used a questionnaire designed to collect epidemiologic, clinical, and laboratory data.

In a prior pilot study, 20 Joint association of Apgar scores and early neonatal symptoms with minor disabilities at school age. For a difference between the two values of 1. Patients were randomized using a single sequence of random assignments, with a simple randomization table between the two arms of the study Fluids A and B. The physician in charge of the patient consulted this randomization table and assigned the child to Group A or B.

Descriptive statistics were calculated for the whole sample and for Groups A and B. The data were tested for normality, as required by subsequent parametric statistical tests. The univariate analysis also utilized X 2. Statistical significance level was set at 0. In Groups A and B, 5 and 30 episodes, respectively, were excluded because of missing data considered relevant for the study.

At the end, there were patients in Group A and in Group B, for a total of patients analyzed Fig. Figure 1 Study flowchart. From the patients included in the study, were male and 42 were neonates. Their median age was 12 months minimum age 0. Seventy-five Median PIM2 was 1. One hundred twenty one were admitted for a respiratory problem, 65 after major surgery, 24 for shock, and 23 had miscellaneous conditions. Fifty-three patients were mechanically ventilated.

Mean and median urine output were, respectively, 2. Fifty-one had hemodynamic instability. Volume expansion was needed in 43 patients, diuretics in , blood products in 35, and inotropics in The 35 patients excluded from the study had a median age of 13 months, 19 were male, and their mean sodium was Descriptive statistics show that both groups were similar regarding age, gender, chronic disease, PIM2, diagnostic groups, mechanical ventilation, Na, Cl, pH at the beginning of the study, water balance, volume administered, and urine output.

Use of diuretics and volume expansion were statistically similar in both groups Table 1. Using Fluid A, serum Na increased from Urinary Na in this group had a mean of Clinical symptomatology due to hypernatremia or hyponatremia was not registered. With Fluid B, at T0, serum Na was In these 14 patients, the differences in Na between T0 and T24 varied from 0.

None of these patients had clinical signs of hyponatremia. Two patients had hypernatremia Na of There were no statistically significant differences using these maintenance fluids.

Saline 0. Fluid A increased serum Cl levels from Fluid B changed the initial Cl from Based on different physiologic knowledge, neonates are expected to behave differently from older children in relation to electrolyte balance. This study observed those aspects and concluded that neonates in Group A had greater increases in Na serum concentration 5.

In Group B, no differences were detected in these parameters between neonates and older children. No differences were seen between neonates and children in relation to urinary electrolyte excretion and urinary output.

Differences were detected between major diagnostic groups, as subsequently explained Table 3. Thumbnail Table 3 Differences in electrolytes variation between diagnostic groups: respiratory and post-surgical.

Urinary excretion with Fluid A was In post-operative patients, urinary excretion of Na was The differences in serum Na when using Fluids A or B were not statistically significant. In this group of patients, electrolyte urinary excretion was significantly different between the two groups, and the difference in serum electrolytes was not statistically significant.

The risk of hypernatremia using saline 0. Apgar score and hospitalization for epilepsy in childhood: a registry-based cohort study. BMC Public Health. Both fluids induced marked urinary excretion of Na. Saba et al. Successful Brazilian experiences in the field of health information. They did not analyze changes in pH or chloride concentrations, nor the urinary excretion of electrolytes.

Rey et al. They also concluded that hypotonic fluids increased the risk of hyponatremia. They described only one case of hypernatremia with normal saline. This discrepancy may be due to different clinical and therapeutic situations between studies different hemodynamic status , although they were both conducted in PICUs.

Yung and Keeley 23 Jewell NP. Statistics for Epidemiology. Their sample was smaller and in some aspects different from the population studied in this study: most of the patients were surgical, mildly ill, and not ventilated. They also studied the Na urinary output, which was similar in both groups and lower than that of the present sample.

In the present study, the hypotonic fluid studied also induced hyponatremia. There are studies including only post-operative patients 24 Cien Saude Colet. Rev Paul Pediatr. The Apgar score revisited: influence of ges- tational age. The 0. Coulthard et al. The present results agree with these conclusions. Effects on acid-base balance were also regarded. The Apgar score and its components in the preterm infant. Pedi- atrics. In this sample of acutely ill medical and surgical patients, 0.

These results strengthen the choice of an isonatremic maintenance fluid in this group of patients. This study has several strengths beyond the size of the sample.

To the authors' knowledge, no other studies focused on the effect of maintenance fluids on serum Cl concentrations or acid-base balance. In this study, no effects on acid-base balance were seen with the use of the two different fluids. Individualizing two diagnostic groups respiratory and postoperative showed different effects on Na and Cl concentrations. This raises the possibility of interference of different hormonal or multifactorial mechanisms.

Postoperative patients excreted higher concentrations of Na and Cl, which may be related to ADH secretion. McCluskey et al. Awoleke JO. Maternal risk factors for low birth weight babies in Lagos, Nigeria. Certain limitations inherent to this study must be recognized: 35 patients were excluded 5 from Group A and 30 from Group B due to missing data or interruption of the study; demonstrating that the two groups studied were similar at the beginning of the study, and that the 35 patients excluded had the same epidemiologic characteristics as the patients included attenuates this limitation.

With this prospective controlled randomized study, it has been observed that although both saline 0. No clinical signs of hypernatremia or hyponatremia were detected. None of the fluids induced hyperchloremic metabolic acidosis. Antibodies Advanced Search. Biochemicals and Reagents. Biological Buffers. Custom Services and Products.

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