Association between maintenance fluid tonicity and hospital-acquired hyponatremia

Francis Carandang, Andrew Anglemyer, Christopher A. Longhurst, Gomathi Krishnan, Steven R. Alexander, Madelyn Kahana, Scott M. Sutherland

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Objective To evaluate whether the administration of hypotonic fluids compared with isotonic fluids is associated with a greater risk for hyponatremia in hospitalized children. Study design Informatics-enabled cohort study of all hospitalizations at Lucile Packard Children's Hospital between April 2009 and March 2011. Extraction and analysis of electronic medical record data identified normonatremic hospitalized children who received either hypotonic or isotonic intravenous maintenance fluids upon admission. The primary exposure was the administration of hypotonic maintenance fluids, and the primary outcome was the development of hyponatremia (serum sodium <135 mEq/L). Results A total of 1048 normonatremic children received either hypotonic (n = 674) or isotonic (n = 374) maintenance fluids upon admission. Hyponatremia developed in 260 (38.6%) children who received hypotonic fluids and 104 (27.8%) of those who received isotonic fluids (unadjusted OR 1.63; 95% CI 1.24-2.15, P <.001). After we controlled for intergroup differences and potential confounders, patients receiving hypotonic fluids remained more likely to develop hyponatremia (aOR 1.37, 95% CI 1.03-1.84). Multivariable analysis identified additional factors associated with the development of hyponatremia, including surgical admission (aOR 1.44, 95% CI 1.09-1.91), cardiac admitting diagnosis (aOR 2.08, 95% CI 1.34-3.20), and hematology/oncology admitting diagnosis (aOR 2.37, 95% CI 1.74-3.25). Conclusions Hyponatremia was common regardless of maintenance fluid tonicity; however, the administration of hypotonic maintenance fluids compared with isotonic fluids was associated with a greater risk of developing hospital-acquired hyponatremia. Additional clinical characteristics modified the hyponatremic effect of hypotonic fluid, and it is possible that optimal maintenance fluid therapy now requires a more individualized approach.

Original languageEnglish (US)
Pages (from-to)1646-1651
Number of pages6
JournalJournal of Pediatrics
Volume163
Issue number6
DOIs
StatePublished - Dec 2013
Externally publishedYes

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Hyponatremia
Maintenance
Hospitalized Child
Informatics
Electronic Health Records
Fluid Therapy
Hematology
Hospitalization
Cohort Studies
Sodium
Serum

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Carandang, F., Anglemyer, A., Longhurst, C. A., Krishnan, G., Alexander, S. R., Kahana, M., & Sutherland, S. M. (2013). Association between maintenance fluid tonicity and hospital-acquired hyponatremia. Journal of Pediatrics, 163(6), 1646-1651. https://doi.org/10.1016/j.jpeds.2013.07.020

Association between maintenance fluid tonicity and hospital-acquired hyponatremia. / Carandang, Francis; Anglemyer, Andrew; Longhurst, Christopher A.; Krishnan, Gomathi; Alexander, Steven R.; Kahana, Madelyn; Sutherland, Scott M.

In: Journal of Pediatrics, Vol. 163, No. 6, 12.2013, p. 1646-1651.

Research output: Contribution to journalArticle

Carandang, F, Anglemyer, A, Longhurst, CA, Krishnan, G, Alexander, SR, Kahana, M & Sutherland, SM 2013, 'Association between maintenance fluid tonicity and hospital-acquired hyponatremia', Journal of Pediatrics, vol. 163, no. 6, pp. 1646-1651. https://doi.org/10.1016/j.jpeds.2013.07.020
Carandang F, Anglemyer A, Longhurst CA, Krishnan G, Alexander SR, Kahana M et al. Association between maintenance fluid tonicity and hospital-acquired hyponatremia. Journal of Pediatrics. 2013 Dec;163(6):1646-1651. https://doi.org/10.1016/j.jpeds.2013.07.020
Carandang, Francis ; Anglemyer, Andrew ; Longhurst, Christopher A. ; Krishnan, Gomathi ; Alexander, Steven R. ; Kahana, Madelyn ; Sutherland, Scott M. / Association between maintenance fluid tonicity and hospital-acquired hyponatremia. In: Journal of Pediatrics. 2013 ; Vol. 163, No. 6. pp. 1646-1651.
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abstract = "Objective To evaluate whether the administration of hypotonic fluids compared with isotonic fluids is associated with a greater risk for hyponatremia in hospitalized children. Study design Informatics-enabled cohort study of all hospitalizations at Lucile Packard Children's Hospital between April 2009 and March 2011. Extraction and analysis of electronic medical record data identified normonatremic hospitalized children who received either hypotonic or isotonic intravenous maintenance fluids upon admission. The primary exposure was the administration of hypotonic maintenance fluids, and the primary outcome was the development of hyponatremia (serum sodium <135 mEq/L). Results A total of 1048 normonatremic children received either hypotonic (n = 674) or isotonic (n = 374) maintenance fluids upon admission. Hyponatremia developed in 260 (38.6{\%}) children who received hypotonic fluids and 104 (27.8{\%}) of those who received isotonic fluids (unadjusted OR 1.63; 95{\%} CI 1.24-2.15, P <.001). After we controlled for intergroup differences and potential confounders, patients receiving hypotonic fluids remained more likely to develop hyponatremia (aOR 1.37, 95{\%} CI 1.03-1.84). Multivariable analysis identified additional factors associated with the development of hyponatremia, including surgical admission (aOR 1.44, 95{\%} CI 1.09-1.91), cardiac admitting diagnosis (aOR 2.08, 95{\%} CI 1.34-3.20), and hematology/oncology admitting diagnosis (aOR 2.37, 95{\%} CI 1.74-3.25). Conclusions Hyponatremia was common regardless of maintenance fluid tonicity; however, the administration of hypotonic maintenance fluids compared with isotonic fluids was associated with a greater risk of developing hospital-acquired hyponatremia. Additional clinical characteristics modified the hyponatremic effect of hypotonic fluid, and it is possible that optimal maintenance fluid therapy now requires a more individualized approach.",
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AU - Alexander, Steven R.

AU - Kahana, Madelyn

AU - Sutherland, Scott M.

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N2 - Objective To evaluate whether the administration of hypotonic fluids compared with isotonic fluids is associated with a greater risk for hyponatremia in hospitalized children. Study design Informatics-enabled cohort study of all hospitalizations at Lucile Packard Children's Hospital between April 2009 and March 2011. Extraction and analysis of electronic medical record data identified normonatremic hospitalized children who received either hypotonic or isotonic intravenous maintenance fluids upon admission. The primary exposure was the administration of hypotonic maintenance fluids, and the primary outcome was the development of hyponatremia (serum sodium <135 mEq/L). Results A total of 1048 normonatremic children received either hypotonic (n = 674) or isotonic (n = 374) maintenance fluids upon admission. Hyponatremia developed in 260 (38.6%) children who received hypotonic fluids and 104 (27.8%) of those who received isotonic fluids (unadjusted OR 1.63; 95% CI 1.24-2.15, P <.001). After we controlled for intergroup differences and potential confounders, patients receiving hypotonic fluids remained more likely to develop hyponatremia (aOR 1.37, 95% CI 1.03-1.84). Multivariable analysis identified additional factors associated with the development of hyponatremia, including surgical admission (aOR 1.44, 95% CI 1.09-1.91), cardiac admitting diagnosis (aOR 2.08, 95% CI 1.34-3.20), and hematology/oncology admitting diagnosis (aOR 2.37, 95% CI 1.74-3.25). Conclusions Hyponatremia was common regardless of maintenance fluid tonicity; however, the administration of hypotonic maintenance fluids compared with isotonic fluids was associated with a greater risk of developing hospital-acquired hyponatremia. Additional clinical characteristics modified the hyponatremic effect of hypotonic fluid, and it is possible that optimal maintenance fluid therapy now requires a more individualized approach.

AB - Objective To evaluate whether the administration of hypotonic fluids compared with isotonic fluids is associated with a greater risk for hyponatremia in hospitalized children. Study design Informatics-enabled cohort study of all hospitalizations at Lucile Packard Children's Hospital between April 2009 and March 2011. Extraction and analysis of electronic medical record data identified normonatremic hospitalized children who received either hypotonic or isotonic intravenous maintenance fluids upon admission. The primary exposure was the administration of hypotonic maintenance fluids, and the primary outcome was the development of hyponatremia (serum sodium <135 mEq/L). Results A total of 1048 normonatremic children received either hypotonic (n = 674) or isotonic (n = 374) maintenance fluids upon admission. Hyponatremia developed in 260 (38.6%) children who received hypotonic fluids and 104 (27.8%) of those who received isotonic fluids (unadjusted OR 1.63; 95% CI 1.24-2.15, P <.001). After we controlled for intergroup differences and potential confounders, patients receiving hypotonic fluids remained more likely to develop hyponatremia (aOR 1.37, 95% CI 1.03-1.84). Multivariable analysis identified additional factors associated with the development of hyponatremia, including surgical admission (aOR 1.44, 95% CI 1.09-1.91), cardiac admitting diagnosis (aOR 2.08, 95% CI 1.34-3.20), and hematology/oncology admitting diagnosis (aOR 2.37, 95% CI 1.74-3.25). Conclusions Hyponatremia was common regardless of maintenance fluid tonicity; however, the administration of hypotonic maintenance fluids compared with isotonic fluids was associated with a greater risk of developing hospital-acquired hyponatremia. Additional clinical characteristics modified the hyponatremic effect of hypotonic fluid, and it is possible that optimal maintenance fluid therapy now requires a more individualized approach.

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