IV maintenance fluids at McMaster Children's Hospital: A survey of physicians
CCCF ePoster library. almehrezi s. Oct 2, 2017; 198117
Dr. shaikha almehrezi almehrezi
Dr. shaikha almehrezi almehrezi
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Abstract
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IV maintenance fluids at McMaster Children's Hospital: A survey of physicians

S Almehrezi M Duffet, K Choong

Department of pediatrics, McMaster University/McMaster Children's Hospital, Hamilton, Ontario,Canada


IV Maintenance Fluids at McMaster Children’s Hospital: A Survey of Physicians.
 
S Almehrezi, M Duffett K Choong
Department of Pediatrics, McMaster University/McMaster Children’s Hospital, Hamilton, Ontario, Canada
 
Introduction:
There are multiple controversies regarding fluid management in pediatrics, such as the ideal maintenance fluids, crystalloids vs colloids for volume expansion, and what appropriate volume of fluids to administer. In addition, awareness of the incidence of hyperchloremia and its associated morbidities is rising.
 
Objectives
To describe physicianss’sphysician’ stated practices and preferences regarding IV fluids in hospitalized children, specifically with respect to: preferred solutions for maintenance and volume expansion, volume of administration, and frequency of monitoring; as well as their knowledge of IV fluid composition.
 
Methods
Self-administered electronic survey, to trainee and attending physicians at McMaster Children’s Hospital. We generated items according to domains of interest, and pre-tested the survey. Surveys were emailed with up to 2 reminders, from May and July 2016.
 
Preliminary Results
140 physicians responded: 53 (52%) staff, 11 (11%) fellows and 38 (37%) residents. The mMajority of respondents prefer isotonic maintenance fluids for all age groups: infants (77%), preschoolers (86%), children (89%) and adolescents (91%). However, some clinicians prefer hypotonic solutions particularly in for infants (16% of respondents) and preschoolers (12%). With respect to additives, 78% respondents routinely prescribe potassium; dextrose is not routinely prescribed in adolescents in 31% respondents. Respondents monitored serum electrolytes once daily or less frequently 38% in patients receiving IV fluids. Respondents typically were aware of the sodium content of 0.9% NaCl solutions (88% correct responses), while 53% correctly reported the sodium content of Ringer’s Lactate (RL). Respondents were less aware of chloride content (66% and 36% correct responses for 0.9% NaCl and RL respectively). Respondents were generally unaware of the sodium and chloride content of other solutions (5-11% correct responses for plasmalyte, 5% Albumin). Regarding volume expansion, 0.9%NaCl is the preferred solution in 85% respondents, followed by RL (14%). In a septic shock scenario, 24% and 69% would consider starting inotropes after 40 mL/kg and 60 mL/kg respectively, of volume expansion.
 
 
Conclusions
Isotonic solutions are now the preferred maintenance solution. Clinicians do not have good knowledge of electrolyte content of commonly prescribed fluids beyond 0.9%NaCl. There may be a shift in practice towards a more conservative approach to volume expansion prior to inotropes.
 
 
 
 
 
 
 
 

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