Hidratación parenteral en Pediatría. Cambios de paradigmas?
Palabras clave:
Fluido de mantenimiento, fluido parenteral, hiponatremiaResumen
Los fluidos de mantenimiento intravenosos (IV) son diseñados para mantener la homeostasis cuando el paciente es incapaz de ingerir el agua requerida, electrolitos, y energía. La tradicional determinación de fluidos de volumen y su composición data del artículo de Hollyday y Segar del año 1957, el cuál describe la relación entre peso, gasto energético, pérdidas fisiológicas y niños sanos. Basados en estas estimaciones de requerimientos diarios de electrolitos, esta información apoya el uso de fluidos hipotónicos que fueron ampliamente usados en pediatría. Sin embargo el uso de los fluidos hipotónicos en pacientes hospitalizados quienes pueden tener desarreglos fisiológicos, menos gasto calórico, disminución del ritmo diurético, y elevados niveles de hormona antidiurética no constituye una alternativa óptima. Varios trabajos han demostrado en las 2 últimas décadas que las soluciones hipotónicas pueden llevar a un aumento de la incidencia de hiponatremia. Está alteración electrolítica puede ser muy dañina y peligrosa para el organismo desde graves patologías neurológicas hasta la muerte. Esta revisión presenta la evidencia para el uso de fluidos isotónicos más que hipotónicos como solución intravenosa de mantenimiento.
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1. Holliday MA, Segar WE. The maintenance need for water in parenteral fluid therapy. Pediatrics. 1957;19:823-32. [ Links ]
2. Cavari Y, Pitfield A, Kisson N. Intravenous Maintenance fluids revisited. Ped Emergency Care. 2013;29:1225-1228. [ Links ]
3. Yung M, Keeley S. Randomised controlled trial of intravenous maintenance fluids. J Paediatr Child Health. 2009;45:9-14. [ Links ]
4. Moritz M, Ayus JC. Prevention of hospital acquired hyponatremia: a case for using isotonic salive. Pediatrics. 2003;111(2):227-30. [ Links ]
5. Anderson RJ. Hospital-associated hyponatremia. Kidney Int. 1986;29:1237-1247. [ Links ]
6. Adrogue HJ, Madias NE. Hyponatremia. N Engl J Med. 2000;342:1581-1589. [ Links ]
7. Kennedy PG, Mitchell DM, Hoffbrand BI. Severe hyponatraemia in hospital inpatients. BMJ.1978;2:1251-1253. [ Links ]
8. Hoorn EJ, Geary D, Robb M, Halperin ML, Bohn D. Acute hyponatremia related to intravenous fluid administration in hospitalized children: an observational study. Pediatrics. 2004;113:1279-1284. [ Links ]
9. Bhalla P, Eaton FE, Coulter JB, Amegavie FL, Sills JA, Abernethy LJ. Hyponatraemic seizures and excessive intake of hypotonic fluids in Young children. BMJ.1999;319:1554-1557. [ Links ]
10 .Moritz ML, Ayus JC. Preventing neurological complications from dysnatremias in children.Pediatr Nephrol. 2005;20(12):1687-1700. [ Links ]
11. Neville KA, Verge CF, O Meara MW, Walker JL. High antidiuretic hormone levels and hyponatremia in children with gastroenteritis. Pediatrics. 2005;116:1401-1407. [ Links ]
12. Skippen P, Adderley R, Bennett M, Cogswell A, Froese N, Seear M, Wensley D. Iatrogenic hyponatremia in hospitalized children: can it be avoided? Paediatr Child Health. 2008;13:502-506. [ Links ]
13. Steele A, Gowrishankar M, Abrahamson S, Mazer CD, Feldman RD, Halperin ML. Postoperative hyponatremia despite near-isotonic saline infusion: a phenomenon of desalination. Ann Intern Med. 1997;126:20-25. [ Links ]
14. Bohn D. Children are another group at risk of hyponatraemia perioperatively. BMJ. 1999;319:1269. [ Links ]
15. Judd BA, Haycock GB, Dalton RN,Chantler C. Antidiuretic hormone following surgery in children. Acta Paediatr Scand. 1990;79:461-466. [ Links ]
16. Neville KA, Sandeman DJ, Rubinstein A, Henry GM, McGlynn M, Walker JL. Prevention of hyponatremia during maintenance intravenous fluid administration: a prospective randomized study of fluid type versus fluid rate. J Pediatr. 2010;156:313-319.e1-2. [ Links ]
17. Choong K, Kho ME, Menon K, et al. Hypotonic versus isotonic saline in hospitalized children: a systematic review. Arch Dis Child. 2006;91:828-35. [ Links ]
18. Wang J, Xu E, Yanfeng Xiao. Isotonic Versus Hypotonic Maintenance IV fluids in hospitalized children: a meta-analysis.Pediatrics. 2014;133;105. [ Links ]
19. Halberthal M, Halperin ML, Bohn D. Lesson of the week: acute hyponatraemia in children admitted to hospital: retrospective analysis of factors contributing to its development and resolution. BMJ. 2001;322:780-82. [ Links ]
20. Choong K, Arora S, Cheng J, Farrokhyar F, Reddy D, Thabane L, Walton JM. Hypotonic versus isotonic maintenance fluids after surgery for children: a randomized controlled trial. Pediatrics. 2011;128:857-66. [ Links ]
21. Rey C, Los-Arcos M, Hernandez A, et al. Hypotonic versus isotonic maintenance fluids in critically ill children: a multicenter prospective randomized study. Acta Paediatr. 2011;100:1138-1143. [ Links ]
22. Arieff AI, Ayus JC, Fraser CL. Hyponatraemia and death or permanent brain damage in healthy children. BMJ. 1992;304:1218-1222. [ Links ]
23. Moritz ML, Ayus JC. New aspects in the pathogenesis, prevention, and treatment of hyponatremic encephalopathy in children. Pediatr Nephrol. 2010;25:1225-1238. [ Links ]
24. Arieff AI. Hyponatremia, convulsions, respiratory arrest, and permanent brain damage after elective surgery in healthy women. N Engl J Med.1986;314:1529-1535. [ Links ]
25. Morits A, Ayus JC. Alteraciones del metabolismo hídrico en la infancia: hiponatremia e hipernatremia. Pediatrics in Review. 2003;24(3):83-91. [ Links ]
26. Carlotti AP, Bohn D, Rutka JT, Singh S, Berry WA, Sharman A, Cusimano M, Halperin ML. A method to estimate urinary electrolyte excretion in patients at risk for developing cerebral salt wasting. J Neurosurg. 2001;95:420-24. [ Links ]
27. Ayus JC, Arieff AI. Brain damage and postoperative hyponatremia.Neurology 1996;46:323-38. [ Links ]
28. Varavithya W, Hellerstein S. Acute symptomatic hyponatremia. J Pediatr. 1967;71:269-83. [ Links ]
29. Welt LG, Orloss J, Kydd DM, Oltman JE. An example of celular hyperosmolarity. J Clin Invest. 1950;29:935-39. [ Links ]
30. Snaith R, Peutrell J, Ellis D. An audit of intravenous fluid prescribing and plasma electrolyte monitoring; a comparison with guidelines from the National Patient Safety Agency. Paediatr Anaesth. 2008;18:940-46. [ Links ]
31. Kannan L, Lodha R. Appropriate fluid for intravenous maintenance therapy in hospitalized children current status. Indian J Pediatr. 2011;78:357-59. [ Links ]
32. Carandang F, Anglemyer A, Longhurst C, Krishnan G, Alexander SR, Kahana M, Sutherland SM. Association between Maintenance Fluid Tonicity and Hospital-Acquired Hyponatremia. J Pediatr. 2013;163(6):1646-1651. [ Links ]
33. Hatherill M, Waggie Z, Salie S, Argent A. Hospital-acquired hyponatremia is associated with excessive administration of intravenous maintenance fluid. Pediatrics. 2004;114:1368-1369. [ Links ]
34. Singhi S, Jayashre M. Free water excess is not the main cause for hyponatremia in critically ill children receiving conventional maintenance fluids. Indian Pediatr. 2009;46:577-83. [ Links ]
35. Arikan A, Zappitelli M, Goldstein S, Naipaul A, Jefferson L, Loftis L. Fluid overload is associated with impaired oxygenation and morbidity in critically ill children. Pediatr Crit Care Med. 2012;13:253-58. [ Links ]
36. Sutherland S, ZappitelliM, Alexander S, Chua A, Brophy P, Bunchman T,et al. Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. Am J Kidney Dis. 2010;55:316-25. [ Links ]
37. Bello O, Priego J .Sal y Agua. Montevideo: Bibliomédica; 2010. [ Links ]
38. Eulmesekian P, Pérez A, Minces P, Bohn D. Hospital-acquired hyponatremia in postoperative pediatric patiens: prospective observtional study. Pediatr Crit Care Med. 2010;11:479-83. [ Links ]
39. Hughes PD, McNicol D, Mutton PM, Flynn GJ, Tuck R, Yorke P. Posoperative hyponatraemic encephalopathy: water intoxication. Aus N Z Surg. 1998;68:165-68. [ Links ]
40. McRae RG, Weissburg AJ, Chang KW. Iatrogenic hyponatremia: a cause of death following pediatric tonsillectomy. Int J Pediatr Otorhinolaryngol. 1994;30:227-32. [ Links ]
41. Saba TG, Fairbairn J, Houghton F, Laforte D, Foster BJ. A randomized controlled trial of isotonic versus hypotonic maintenance intravenous fluids in hospitalized children. BMC Pediatr. 2011;11:82. [ Links ]
42. Freeman MA, Ayus JC, Moritz ML. Maintenance intravenous fluid prescribing practices among paediatric residents. Acta Paediatr. 2012;101(10):e465-e468. [ Links ]
2. Cavari Y, Pitfield A, Kisson N. Intravenous Maintenance fluids revisited. Ped Emergency Care. 2013;29:1225-1228. [ Links ]
3. Yung M, Keeley S. Randomised controlled trial of intravenous maintenance fluids. J Paediatr Child Health. 2009;45:9-14. [ Links ]
4. Moritz M, Ayus JC. Prevention of hospital acquired hyponatremia: a case for using isotonic salive. Pediatrics. 2003;111(2):227-30. [ Links ]
5. Anderson RJ. Hospital-associated hyponatremia. Kidney Int. 1986;29:1237-1247. [ Links ]
6. Adrogue HJ, Madias NE. Hyponatremia. N Engl J Med. 2000;342:1581-1589. [ Links ]
7. Kennedy PG, Mitchell DM, Hoffbrand BI. Severe hyponatraemia in hospital inpatients. BMJ.1978;2:1251-1253. [ Links ]
8. Hoorn EJ, Geary D, Robb M, Halperin ML, Bohn D. Acute hyponatremia related to intravenous fluid administration in hospitalized children: an observational study. Pediatrics. 2004;113:1279-1284. [ Links ]
9. Bhalla P, Eaton FE, Coulter JB, Amegavie FL, Sills JA, Abernethy LJ. Hyponatraemic seizures and excessive intake of hypotonic fluids in Young children. BMJ.1999;319:1554-1557. [ Links ]
10 .Moritz ML, Ayus JC. Preventing neurological complications from dysnatremias in children.Pediatr Nephrol. 2005;20(12):1687-1700. [ Links ]
11. Neville KA, Verge CF, O Meara MW, Walker JL. High antidiuretic hormone levels and hyponatremia in children with gastroenteritis. Pediatrics. 2005;116:1401-1407. [ Links ]
12. Skippen P, Adderley R, Bennett M, Cogswell A, Froese N, Seear M, Wensley D. Iatrogenic hyponatremia in hospitalized children: can it be avoided? Paediatr Child Health. 2008;13:502-506. [ Links ]
13. Steele A, Gowrishankar M, Abrahamson S, Mazer CD, Feldman RD, Halperin ML. Postoperative hyponatremia despite near-isotonic saline infusion: a phenomenon of desalination. Ann Intern Med. 1997;126:20-25. [ Links ]
14. Bohn D. Children are another group at risk of hyponatraemia perioperatively. BMJ. 1999;319:1269. [ Links ]
15. Judd BA, Haycock GB, Dalton RN,Chantler C. Antidiuretic hormone following surgery in children. Acta Paediatr Scand. 1990;79:461-466. [ Links ]
16. Neville KA, Sandeman DJ, Rubinstein A, Henry GM, McGlynn M, Walker JL. Prevention of hyponatremia during maintenance intravenous fluid administration: a prospective randomized study of fluid type versus fluid rate. J Pediatr. 2010;156:313-319.e1-2. [ Links ]
17. Choong K, Kho ME, Menon K, et al. Hypotonic versus isotonic saline in hospitalized children: a systematic review. Arch Dis Child. 2006;91:828-35. [ Links ]
18. Wang J, Xu E, Yanfeng Xiao. Isotonic Versus Hypotonic Maintenance IV fluids in hospitalized children: a meta-analysis.Pediatrics. 2014;133;105. [ Links ]
19. Halberthal M, Halperin ML, Bohn D. Lesson of the week: acute hyponatraemia in children admitted to hospital: retrospective analysis of factors contributing to its development and resolution. BMJ. 2001;322:780-82. [ Links ]
20. Choong K, Arora S, Cheng J, Farrokhyar F, Reddy D, Thabane L, Walton JM. Hypotonic versus isotonic maintenance fluids after surgery for children: a randomized controlled trial. Pediatrics. 2011;128:857-66. [ Links ]
21. Rey C, Los-Arcos M, Hernandez A, et al. Hypotonic versus isotonic maintenance fluids in critically ill children: a multicenter prospective randomized study. Acta Paediatr. 2011;100:1138-1143. [ Links ]
22. Arieff AI, Ayus JC, Fraser CL. Hyponatraemia and death or permanent brain damage in healthy children. BMJ. 1992;304:1218-1222. [ Links ]
23. Moritz ML, Ayus JC. New aspects in the pathogenesis, prevention, and treatment of hyponatremic encephalopathy in children. Pediatr Nephrol. 2010;25:1225-1238. [ Links ]
24. Arieff AI. Hyponatremia, convulsions, respiratory arrest, and permanent brain damage after elective surgery in healthy women. N Engl J Med.1986;314:1529-1535. [ Links ]
25. Morits A, Ayus JC. Alteraciones del metabolismo hídrico en la infancia: hiponatremia e hipernatremia. Pediatrics in Review. 2003;24(3):83-91. [ Links ]
26. Carlotti AP, Bohn D, Rutka JT, Singh S, Berry WA, Sharman A, Cusimano M, Halperin ML. A method to estimate urinary electrolyte excretion in patients at risk for developing cerebral salt wasting. J Neurosurg. 2001;95:420-24. [ Links ]
27. Ayus JC, Arieff AI. Brain damage and postoperative hyponatremia.Neurology 1996;46:323-38. [ Links ]
28. Varavithya W, Hellerstein S. Acute symptomatic hyponatremia. J Pediatr. 1967;71:269-83. [ Links ]
29. Welt LG, Orloss J, Kydd DM, Oltman JE. An example of celular hyperosmolarity. J Clin Invest. 1950;29:935-39. [ Links ]
30. Snaith R, Peutrell J, Ellis D. An audit of intravenous fluid prescribing and plasma electrolyte monitoring; a comparison with guidelines from the National Patient Safety Agency. Paediatr Anaesth. 2008;18:940-46. [ Links ]
31. Kannan L, Lodha R. Appropriate fluid for intravenous maintenance therapy in hospitalized children current status. Indian J Pediatr. 2011;78:357-59. [ Links ]
32. Carandang F, Anglemyer A, Longhurst C, Krishnan G, Alexander SR, Kahana M, Sutherland SM. Association between Maintenance Fluid Tonicity and Hospital-Acquired Hyponatremia. J Pediatr. 2013;163(6):1646-1651. [ Links ]
33. Hatherill M, Waggie Z, Salie S, Argent A. Hospital-acquired hyponatremia is associated with excessive administration of intravenous maintenance fluid. Pediatrics. 2004;114:1368-1369. [ Links ]
34. Singhi S, Jayashre M. Free water excess is not the main cause for hyponatremia in critically ill children receiving conventional maintenance fluids. Indian Pediatr. 2009;46:577-83. [ Links ]
35. Arikan A, Zappitelli M, Goldstein S, Naipaul A, Jefferson L, Loftis L. Fluid overload is associated with impaired oxygenation and morbidity in critically ill children. Pediatr Crit Care Med. 2012;13:253-58. [ Links ]
36. Sutherland S, ZappitelliM, Alexander S, Chua A, Brophy P, Bunchman T,et al. Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. Am J Kidney Dis. 2010;55:316-25. [ Links ]
37. Bello O, Priego J .Sal y Agua. Montevideo: Bibliomédica; 2010. [ Links ]
38. Eulmesekian P, Pérez A, Minces P, Bohn D. Hospital-acquired hyponatremia in postoperative pediatric patiens: prospective observtional study. Pediatr Crit Care Med. 2010;11:479-83. [ Links ]
39. Hughes PD, McNicol D, Mutton PM, Flynn GJ, Tuck R, Yorke P. Posoperative hyponatraemic encephalopathy: water intoxication. Aus N Z Surg. 1998;68:165-68. [ Links ]
40. McRae RG, Weissburg AJ, Chang KW. Iatrogenic hyponatremia: a cause of death following pediatric tonsillectomy. Int J Pediatr Otorhinolaryngol. 1994;30:227-32. [ Links ]
41. Saba TG, Fairbairn J, Houghton F, Laforte D, Foster BJ. A randomized controlled trial of isotonic versus hypotonic maintenance intravenous fluids in hospitalized children. BMC Pediatr. 2011;11:82. [ Links ]
42. Freeman MA, Ayus JC, Moritz ML. Maintenance intravenous fluid prescribing practices among paediatric residents. Acta Paediatr. 2012;101(10):e465-e468. [ Links ]
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2017-10-22
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Iramain, R. (2017). Hidratación parenteral en Pediatría. Cambios de paradigmas?. Pediatría (Asunción), 41(2), 143-149. Recuperado a partir de https://revistaspp.org/index.php/pediatria/article/view/134
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