An article published in Frontiers in Pediatrics informed that the survival of a child with severe volume depletion at the emergency department depends on the competency of the first responder to recognize and promptly treat hypovolemic shock. 

 

The authors discussed that despite following the basic principles on fluid and electrolytes therapy, a consensus on clinical management protocol is difficult to reach, because more adverse events are reported from fluid administration than for any other drug. Additionally, recent systematic reviews and meta-analyses have highlighted the risk of hyponatremia, and hyponatremic encephalopathy in some children treated with hypotonic fluids. Evidence suggests that isotonic fluids are best suitable for the correction of hypotonic, isonatremic, and hypernatremic dehydration. Although oral rehydration therapy is adequate to correct mild-to-moderate isonatremic dehydration, parenteral fluid therapy is safer for children with severe dehydration and those with changes in serum sodium. The article reviews the pathophysiology of water and sodium metabolism and, it uses the clinical case examples to illustrate the bed-side approach to the management of three different types of dehydration using a pre-mixed isotonic fluid solution (with 20 or 40 mmol/L of potassium chloride added depending on the absence or presence of hypokalemia, respectively). 

 

This article discussed that when 3% sodium chloride is unavailable to treat hyponatremic encephalopathy, 0.9% sodium chloride can be used, provided a closer monitoring of serum sodium is carried out. It is important to conduct regular clinical and laboratory monitoring of the child. Errors resulting from over-hydration can be corrected by the kidneys. The attending physician should ensure that hypovolemic shock is reversed while ongoing losses are replaced, to remove the child from a perpetual state of dehydration.

 

Source: Frontiers in Pediatrics. 2018 Feb; 6: 28. doi: 10.3389/fped.2018.00028