103 Pediatric IV Fluids

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Residency, Student, Medicine, Er, Em, Intern, Health & Fitness, Medical, Education, Emergency

4.6 • 665 Ratings

🗓️ 5 April 2021

⏱️ 117 minutes

🔗️ Recording | iTunes | RSS

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Summary

Pediatric intensivist Dr. Will Cagle joins the show to discuss the AAP Maintenance IV fluid guidelines and considerations when choosing IV fluids for pediatric inpatients.

What do you need to know from the 2018 AAP maintenance IV fluid guideline?

How common is hyponatremia in hospitalized patients and why does it matter to your practice?

What is SIADH and how does it contribute to hyponatremia in acutely ill children?

How can we prevent hyponatremia in our hospitalized patients?

What are the differences between hypotonic and isotonic fluids?

What are balanced solutions and why might they be preferred as compared to saline in some clinical settings?

All of this and more from the Department of Pediatrics and the Medical College of Georgia.

Check out our website for detailed show-notes: https://www.augusta.edu/mcg/pediatrics/residency/podcast.php

Special thanks to Dr. Asif Mansuri and Dr. Gene Fisher for providing peer review for this episode.

Questions, comments, or feedback? Please email us at [email protected]

Want Further Reading? Check out the clinical practice guideline from the AAP and our other references below.

Feld LG,Neuspiel DR, Foster BA, et al. Clinical Practice Guideline: Maintenance Intravenous Fluids in Children. Pediatrics. 2018;142(6):e20183083. doi:10.1542/peds.2018-3083
Semler MW, Self WH, Wanderer JP, et al. Balanced Crystalloids versus Saline in CriticallyIll Adults. N Engl J Med. 2018;378(9):829-839. doi:10.1056/NEJMoa1711584
CuzzoB, Padala SA, Lappin SL. Vasopressin (Antidiuretic Hormone, ADH) [Updated 2020 Apr 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526069/
Chowdhury, Abeed H. BSc, MRCS*; Cox, Eleanor F. PhD†; Francis, Susan T. PhD†; Lobo, Dileep N. DM, FRCS, FACS*A Randomized, Controlled, Double-Blind Crossover Study on the Effects of 2-L Infusions of 0.9% Saline and Plasma-Lyte® 148 on Renal Blood Flow Velocity and Renal Cortical Tissue Perfusion in Healthy Volunteers, Annals of Surgery: July 2012 - Volume 256 - Issue 1 - p 18-24 doi: 10.1097/SLA.0b013e318256be72
Peti-Peterdi J, Harris RC. Maculadensa sensing and signaling mechanisms of renin release. J Am Soc Nephrol. 2010;21(7):1093-1096. doi:10.1681/ASN.2009070759
Wilcox CS. Regulation of renal blood flow by plasma chloride.J Clin Invest. 1983;71(3):726-735. doi:10.1172/jci110820

Transcript

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0:00.0	Hi everyone and welcome back to EM Basic. My name is Zach Hodges and I'm a pediatric
0:05.2	hospitalist at the Medical College of Georgia. Today I have the pleasure of bringing you
0:09.1	another pediatric topic and this is another crossover with the MCG pediatric podcast. I encourage
0:15.2	you to check us out if you'd like to hear more pediatric content. My guest today is Dr. Will
0:20.2	Kagle. He is a pediatric intensivist here at the
0:22.5	Medical College of Georgia. On today's episode, we review some recent updates in pediatric
0:27.3	IV fluid resuscitation, including the 2018 AAP guidelines. We discuss how to reduce the risk
0:33.8	of iatrogenic hyponatremia and some thoughts about using saline versus balanced salt
0:38.3	solutions. With that, let's get started with the case.
0:45.5	Our patient is a four-year-old female who was admitted from the emergency department to the
0:49.4	inpatient award with the history of fever, cough, shortness of breath, and decrease oral intake
0:53.9	for the past two days.
0:55.7	Chess radiograph in the emergency department is notable for an opacity in the right lower
0:59.1	lobe, and she is diagnosed with pneumonia.
1:01.7	She received antibiotics and IV fluid bolus and started on D5 half-normal saline maintenance
1:06.6	IV fluids prior to arrival to the floor.
1:09.5	She was continued on IV fluids overnight, but on the second hospital day, she was noted
1:13.3	to have worsening irritability despite previously improving on her current therapy.
1:17.6	Later in the day, she even developed a generalized tonic-clonic seizure that was not responsive
1:21.7	to IV lorazepam.
1:23.6	On arrival to the pick-you, screening labs were notable for hyponatremia with a sodium of 118.
1:29.4	Let's discuss what's possibly going on and how this complication may have been prevented.
	...

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