Blood chloride levels in children given 0.9% normal saline as fluid for resuscitation followed by isotonic maintenance fluid

Background: In the last few years there have been several studies describing the occurrence of hyperchloraemia following the use of isotonic fluids. These studies have shown variable results with respect to its prevalence and outcomes. Studies in the paediatric population have been sparse.

Objectives: To study the prevalence of hyperchloraemia in the first 48 hours in children who received 0.9% normal saline as fluid for resuscitation and to assess the relationship of hyperchloraemia with outcomes such as use of inotropes, acute kidney injury (AKI), length of stay and mortality.

Method: A cross-sectional study was conducted in the department of paediatrics of a tertiary care hospital; 118 children who were admitted in the paediatric intensive care unit / high dependency unit were enrolled in the study. Blood chloride levels were checked at 0-6 hours, 12-24 hours and 24-48 hours. Data analysis was done using SPSS software version 16 and Microsoft Excel 2007.

Results:Mean age of the sample population was 5.45 ± 3.97 years with 52% of them being boys; 22.9% children developed hyperchloraemia. There were significant differences in chloride levels between the hyperchloraemia and normochloraemia groups at all three-time frames (p <0.000). The chloride levels started to rise after 6 hours of normal saline bolus and continued to show a rising trend with the highest values at 48 hours. The sodium levels at various time points were all within the normal range. Presence of hyperchloraemia was associated with acute kidney injury (AKI) in the study population (p=0.040). However, hyperchloraemia was not associated with the need of inotropes (p=0.058), length of stay (p=0.499) or mortality (p=0.302).

Conclusions: Hyperchloraemia was seen in 22.9% of the study population and there was a significant association with AKI but not with the need of inotropes, length of stay or mortality.

Sri Lanka Journal of Child Health, 2022; 51(3): 385-390