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Fluid management of hypernatraemic dehydration to prevent cerebral oedema: A retrospective case control study of 97 children in China

Authors


Dr. Jianhua Mao, Department of Nephrology, The Children's Hospital of Zhejiang University School of Medicine, Hang Zhou 310006, China. Fax: 0086 571 87033296; email: maojh88@gmail.com

Abstract

Aim:  To compare the fluid management of hypernatraemic dehydration in acute gastroenteritis in those who developed cerebral oedema (cases) versus those who did not (controls).

Methods:  A retrospective study of 97 cases of hypernatraemic dehydration at a tertiary children's hospital in China over five years, in which rehydration regimes of 49 children who developed cerebral oedema were compared with 48 children who made an uneventful recovery.

Results:  Risk factors for cerebral oedema (vs. no cerebral oedema) were an initial fluid bolus (29/49 vs. 15/48, P = 0.006), the mean rate of bolus infusion (14.7 ± 2.2 vs. 10.8 ± 1.4 mL/kg/hr, P < 0.001), the severity of hypernatraemia (serum sodium 167.7 ± 7.8 vs. 161.3 ± 7.9 mmol/L, P < 0.001) and the overall rehydration rate (8.2 ± 1.1 vs. 6.4 ± 0.6 mL/kg/hr, P < 0.001). On logistic regression, a rapid rehydration rate was the most significant contributor to cerebral oedema. From receive operating characteristic (ROC) curve analysis, the safe rate of rehydration was <6.8 mL/kg/hr.

Conclusion:  The key risk factors for the development of cerebral oedema during recovery from hypernatraemic dehydration were too rapid a rate of rehydration, an initial fluid bolus to rapidly expand plasma volume and the severity of the hypernatraemia. Thus, we conclude that a uniformly slow rate of rehydration is the best way of preventing cerebral oedema.

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