What’s the Best Maintenance Fluid for Children – D51/2NS or D5NS?
Spoon Feed
Hypotonic maintenance IV fluid (MIVF) dropped serum sodium at 24 hours compared with isotonic MIVF in pediatric patients. We should stop using D51/2NS for routine MIVF in children.
Source
0.45% Versus 0.9% Saline in 5% Dextrose as Maintenance Fluids in Children Admitted With Acute Illness: A Randomized Control Trial. Pediatr Emerg Care. 2022 Sep 1;38(9):436-441. doi: 10.1097/PEC.0000000000002621. Epub 2022 Jan 26.
More Acute Kidney Injury With Vancomycin Plus… Pip/Tazo Or Ceftolozane/Tazo?
Spoon Feed
Patients receiving vancomycin + piperacillin/tazobactam had greater adjusted odds of acute kidney injury than those receiving vancomycin + ceftolozane/tazobactam.
Source
Nephrotoxicity of Vancomycin in Combination with Beta-lactam Agents: Ceftolozane-tazobactam vs. Piperacillin-tazobactam. Clin Infect Dis. 2022 Aug 19;ciac670. doi: 10.1093/cid/ciac670. Online ahead of print.
How to Manage Hyponatremia – Spoon-Feed Version
Spoon Feed
Regardless of the duration or etiology of hyponatremia, patients that have severe clinical manifestations warrant rapid administration of hypertonic saline as a 100-150 mL bolus of 3% sodium chloride or continuous infusion.
Source
Diagnosis and Management of Hyponatremia: A Review. JAMA. 2022 Jul 19;328(3):280-291. doi: 10.1001/jama.2022.11176.
Back to BaSICS – First Fluid Choice Matters – A Reanalysis of the BaSICS RCT
Spoon Feed
There have been multiple publications since the original SMART and SALT-ED trials, including this Brazilian RCT that initially said fluid choice didn’t matter in critically ill patients. However, a secondary analysis of the BaSICS RCT suggests otherwise.
Source
Association between Type of Fluid Received Prior to Enrollment, Type of Admission, and the Effect of Balanced Crystalloid in Critically Ill Adults. Am J Respir Crit Care Med. 2022;205(12):1419-1428. Doi:10.1164/rccm.202111-2484OC
Recalculating…UTICalc Removes Race as Part of Score
Spoon Feed
Race was strongly associated with UTI risk, with non-Black children having 2-4 times greater odds of infection. However, replacement of race with 2 other variable resulted in similar diagnostic accuracy for the UTICalc tool.
Source
Reassessment of the Role of Race in Calculating the Risk for Urinary Tract Infection: A Systematic Review and Meta-analysis. JAMA Pediatr. 2022 Apr 18. doi: 10.1001/jamapediatrics.2022.0700. Online ahead of print.
How to Treat Cancer-Associated Hypercalcemia
Spoon Feed
Cancer-associated hypercalcemia requires prompt recognition and treatment in the ED, starting with aggressive rehydration +/- loop diuretics as well as coordination of initiation of bone resorption inhibition, which can take up to 48 or longer hours to have a full effect.
Source
Cancer-Associated Hypercalemia. N Engl J Med 2022; 386: 1443-51. DOI 10.1056/NEJMcp2113128.
Do Balanced Fluids Help Critically Ill Children?
Spoon Feed
There is some evidence that bolus treatment in critically ill pediatric patients (28 days old to 18 years old) with balanced fluids (such as LR) versus unbalanced fluids (such as NS) results in improved serum bicarbonate and blood pH values. However, it's not clear if this is clinically beneficial.
Source
Balanced Versus Unbalanced Fluid in Critically Ill Children: Systematic Review and Meta-Analysis. Pediatr Crit Care Med. 2022 Mar 1;23(3):181-191. doi: 10.1097/PCC.0000000000002890.