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Hyponatremia
Everything in the library about hyponatremia — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
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Evidence & Research
3 items
Isotonic maintenance fluid: Practice Gap discussion at Update Course 2018
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At the 6th Annual Pediatric Surgery Update Course, Drs Charles Snyder, Craig Lillehei and David Powell discuss the top ten practice gaps of 2018. Here they discuss type of maintenance fluid, emphasizing use of normotonic fluids to reduce ri
video5:57 · Sep 2018
Maintenance Fluids in Resuscitation: 2018 Pediatric Surgery Practice Gap #4
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Drs. Todd Ponsky, Alex Casar, Alex Gibbons, and Rae Hanke review 2018 Practice Gap #4: Maintenance Fluids in Resuscitation, as identified by the APSA Professional Development Committee.
video · Jun 2019
APSA 2018 Practice Gaps
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At the 7th Annual Pediatric Surgery Update Course, Drs Rae Hanke, Alexandra Casar Berazaluce and Alexander Gibbons recap the 2018 practice gaps identified by the American Pediatric Surgical Association’s Professional Development Committee.
video · Mar 2020
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Isotonic maintenance fluid: Practice Gap discussion at Update Course 2018
Iatrogenic hyponatremia is one of the biggest problems in hospitals, related to ADH physiology and the use of hypotonic fluids rather than normal saline.
clinical1:23 ↗
Children become hyponatremic because they are given half normal saline, and the data on this are clear.
clinical1:23 ↗
The correct maintenance fluid for a 15-year-old post-colectomy patient is D5 normal saline with 20 milliequivalents of potassium.
guideline2:05 ↗
The American Academy of Pediatrics is coming out with a consensus statement on isotonic maintenance fluids (anticipated as of March).
guideline2:31 ↗
Hospitalized children develop hyponatremia because they receive less than isotonic (hypotonic) solutions, leading to cerebral edema and other complications.
clinical2:31 ↗
The traditional teaching was to resuscitate with isotonic fluid and then convert to hypotonic maintenance fluids; the new practice is to keep patients on isotonic fluid to prevent hyponatremia.
guideline2:58 ↗
At ABSA, 48% of respondents correctly identified isotonic fluid as the answer, which the speakers considered a high number given the radical change from traditional teaching.
epidemiological3:30 ↗
Hypotonic fluids were originally developed based on theoretical calculations of sodium and chloride losses by a scientist approximately 100 years ago, not on evidence from real patients.
clinical4:24 ↗
Newborn babies are different because their kidney function is immature when first born, so the amount of electrolytes given changes over the first couple of days of life.
clinical4:47 ↗
Term newborns on the first day of life should receive D10W (dextrose 10% in water) with no saline.
guideline4:47 ↗
In adult critical care literature, practice is shifting from normal saline to lactated Ringer's as the normal isotonic solution, and the same shift is expected to occur in pediatrics.
opinion5:14 ↗
Lactated Ringer's is a more physiologic isotonic solution than normal saline.
clinical5:40 ↗
There is not yet literature in children supporting the use of D5 lactated Ringer's, but it is anticipated.
opinion5:40 ↗
APSA 2018 Practice Gaps
Restrictive transfusion protocols using target hemoglobin of 7 instead of 8, 9, or 10 show no difference in mortality
host_summaryAlex Gibbons0:27 ↗
Sickle cell disease is an exception to restrictive transfusion protocols, requiring hematocrit around 30 or HBSS below 50-60%
clinical2:01 ↗
Early enteral feeding in pancreatitis decreases morbidity, infectious complications, and overall mortality
host_summaryAlex Gibbons2:27 ↗
Nasogastric feeding is equal to nasojejunal feeding in pancreatitis and equally tolerated
host_summaryAlex Gibbons2:27 ↗
Ultrasound is not a great tool for diagnosis of ovarian torsion
host_summaryRae Hanke4:11 ↗
In ovarian torsion, even if the ovary looks black and dead after detorsion, leave it in place because ovaries can still recover and this helps preserve fertility
host_summaryAlejandro Cassar4:39 ↗
For low bleeding risk trauma patients, VTE prophylaxis should include SCDs and low molecular weight heparin
host_summaryRae Hanke4:59 ↗
For high bleeding risk trauma patients, use SCDs until ambulatory, then do screening ultrasound on ICU day 7
host_summaryRae Hanke4:59 ↗
Institutional policy at one center applies VTE prophylaxis with low molecular weight heparin to patients age 12 and over
clinical5:55 ↗
High risk criteria for VTE in trauma include femur fractures, cervical spine fracture, and intubation
clinical5:55 ↗
Kids with IBD are probably the most at-risk group for deep venous thrombosis
clinicalRae Hanke6:52 ↗
Burnout directly impacts patient care and outcomes
host_summaryRae Hanke6:52 ↗
Support systems for physician wellness need to be proactive because when burnt out, surgeons are not likely to seek help
host_summaryRae Hanke6:52 ↗
Physicians should ask parents if there is a firearm in the home, how it is stored, whether it is locked and loaded, whether ammunition is kept separate, and who has access
host_summary12:19 ↗
Current strategy should be to continue isotonic fluids throughout hospitalization rather than switching to hypotonic maintenance fluids
host_summaryAlex Gibbons13:13 ↗
Continuing isotonic fluids decreases the risk of hyponatremia and had similar mortality otherwise
host_summaryAlex Gibbons13:13 ↗
In Wilms tumor surgery, failing to take lymph nodes automatically upstages the patient
host_summaryAlex Gibbons17:10 ↗
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