{"id":8272,"date":"2017-07-27T17:21:52","date_gmt":"2017-07-27T22:21:52","guid":{"rendered":"http:\/\/rebelblog.wpengine.com\/?p=8272"},"modified":"2019-02-07T16:24:41","modified_gmt":"2019-02-07T22:24:41","slug":"balanced-vs-unbalanced-fluids-in-pediatric-severe-sepsis","status":"publish","type":"post","link":"https:\/\/rebelem.com\/balanced-vs-unbalanced-fluids-in-pediatric-severe-sepsis\/","title":{"rendered":"Balanced vs Unbalanced Fluids in Pediatric Severe Sepsis"},"content":{"rendered":"
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\"\"Background: <\/strong>Fluid resuscitation with crystalloid is one of the most basic initial management approaches to adult and pediatric patients with severe sepsis and septic shock. However, which fluid should we be giving, and does it matter?\u00a0 Should we give an unbalanced, chloride rich solution such as normal saline or a balanced, chloride restrictive fluid, such as lactated ringers, Plasma-Lyte, or Normasol? Interestingly, the 2016 Surviving Sepsis Guidelines, added resuscitation with balanced fluids into the guidelines, although a weak recommendation with low quality of evidence.<\/p>\n

This recommendation was based on some growing adult data, albeit retrospective, showing that resuscitation strategies using normal saline may be harmful and associated with increased risk of AKI (1), need for CRRT (1) and increased mortality (2-3). The effects of balanced fluids however, have not been studied in the resuscitation of children in severe sepsis and septic shock.<\/p>\n

A balanced fluid is a fluid that closely resembles the plasma\u2019s electrolyte concentration and its strong ion difference (SID). The SID is the main driving force of our bodies\u2019 acid-base balance and can be calculated by taking the difference between a patient\u2019s serum sodium and chloride levels.\u00a0 Normally patients have a plasma SID close to 40 mEq\/L (Serum Na=140mEq\/L \u2013 Serum Chloride=100 mEq\/L). Giving a fluid like normal saline with a SID=0mEq\/L will decrease the patients serum SID and cause a metabolic acidosis.\u00a0 Giving a fluid with a SID greater than 40 mEq\/L will increase a patients plasma SID and cause a metabolic alkalosis.<\/p>\n

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Clinical Question:<\/strong><\/h3>\n

Is there an association between the use of balanced solutions for resuscitation in pediatric sepsis management and improved outcomes when compared to unbalanced solutions?<\/p>\n

What They Did:<\/strong><\/h3>\n