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There is rarely any need to repeat potassium testing when the laboratory reports hyperkalemia on a hemolyzed sample in a child with a normal blood urea nitrogen (BUN) and creatinine (Cr).
Source
Hyperkalemia in a Hemolyzed Sample in Pediatric Patients: Repeat or Do Not Repeat? Pediatr Emerg Care. 2023 Jan 1;39(1):e1-e5. doi: 10.1097/PEC.0000000000002857. Epub 2022 Sep 29.
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IV crystalloid fluid restriction in the first 24-hours for ED sepsis patients without associated shock significantly reduced volumes when compared to standard of care. A larger trial investigating patient-centered outcomes is likely imminent.
Source
Restrictive fluids versus standard care in adults with sepsis in the emergency department (REFACED): A multicenter, randomized feasibility trial. Acad Emerg Med. 2022 Oct;29(10):1172-1184. doi: 10.1111/acem.14546. Epub 2022 Aug 5.
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This retrospective single-center study found that hypokalemic patients who received magnesium within 4 hours of their potassium supplementation had no significant difference in time to serum potassium normalization.
Source
The Effects of Magnesium Coadminstration During Treatment of Hypokalemia in the Emergency Department. J Emerg Med. 2022 Oct 11:S0736-4679(22)00347-X. doi: 10.1016/j.jemermed.2022.06.007. Epub ahead of print.
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Conservative fluid administration in patients with acute pancreatitis can achieve similar clinical outcomes compared with aggressive resuscitation, with less risk of volume overload.
Source
Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. N Engl J Med. 2022 Sep 15;387(11):989-1000. doi: 10.1056/NEJMoa2202884.
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.
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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.
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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.
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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
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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.
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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.
