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.
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.
Authors: Mendel Castle-Kirszbaum; Mervyn Kyi; Christopher Wright; Tony Goldschlager; R Andrew Danks; W Geoffrey Parkin Journal: Neurosurg Rev Date: 2021-01-03 Impact factor: 3.042
Authors: Mohammed A El-Bayoumi; Alaa M Abdelkader; Mohamed M A El-Assmy; Angi A Alwakeel; Hanem M El-Tahan Journal: Eur J Pediatr Date: 2011-09-10 Impact factor: 3.183