Study of serum electrolytes in preterm infants with RDS, on intravenous fluids, during the first 48 hours of age

Disorders in fluid and electrolyte balance are among the most commonly encountered problems in the care of preterm infants especially with RDS. The aim of this study is to assess the most important serum electrolytes [Na, K and Cl] in preterm infants with RDS, on intravenous fluids, during the first 48 hours of age. Thirty preterm infants with RDS on intravenous fluid therapy were included in this study. They were classified into 4 groups: group 1 [NBW] included 5 preterms, group 2 [LBW] included 16 preterms, group 3 [VLBW] included 5 preterms and group 4 [ELBW] included 4 preterms. All of them were subjected to full history perinatal taking, thorough clinical examination and lab investigations including serum electrolytes [serum Na, K and Cl] on admission [initial sample] and after 48 hours [follow-up sample]. The results of the study revealed that hyponatremia was more prevalent in the initial sample [50-80%] than the follow-up sample [37-60%] in all studied groups, and the percentage persisted as much as 50% in ELBW in both samples. Hyperkalemia was also present with high percentage in the initial and the follow-up samples [20-60%] in all studied groups. Hypochloremia appeared in NBW and VLBW infants in the initial sample [20% and 40% respectively], while in the F.U. sample decreased to 20% in VLBW and disappeared in NBW infants. In LBW group, there was a statistically significant increase in serum sodium in F.U. sample compared to the initial sample [P < 0.05], while there was no significant difference between serum sodium levels in both samples in the other studied groups [P > 0.05]. No significant difference was found between the initial sample and F.U. sample regarding serum potassium and chloride levels in all studied groups [P > 0.05]. In conclusion, each of prematurity and RDS by itself enhance the occurrence of electrolyte abnormalities due to many factors. So, serial F.U. measurement of S.E. since delivery till establishment of adequate oral feeding helps in early detection of S.E. abnormalities and adjustment of IVF therapy

Transient lactic acidosis as a side effect of inhaled salbutamol therapy in asthmatic children

In spite of the effectiveness of inhaled beta-2 agonists as bronchodilator therapy in bronchial asthma management in children; they produce a number of biochemical changes. The clinical relevance of these biochemical changes is not clearly defined. One of these observed changes is the transient lactatemia. The aim of this study is to evaluate the presence of lactic acidosis as a transient side effect of inhaled salbutamol therapy during the management of asthmatic attacks. Thirty-six asthmatic children presenting in acute asthma, 20 males and 16 females with age range between 6 and 10 years [mean +/- SD: 7.47 +/- 1.13 years], were included in this study. All of them were subjected to full history taking, thorough clinical examination and lab evaluation including: Serum lactate levels before salbutamol inhalation therapy, one hour after start of inhalation therapy and 24 hours later. Blood gas analysis before and after inhalation therapy were also done. Salbutamol inhalation therapy was given to all patients in the form of 3-successive doses, 20 minutes apart, in a dose of 0.15 mg/kg/dose, thereafter intensive management was continued. A statistically highly significant increase in the early post treatment serum lactate level was found in comparison to both pre treatment and 24 hours post treatment levels. In spite of the return of serum lactate levels to normal limits, the difference between the 24-hour post treatment and pre treatment levels was also statistically highly significant. The results of this study confirm that transient lactic acidosis occurs as a side effect of inhaled salbutamol. Physicians should be aware of this side effect of bronchodilators, which might prove of clinical significance in the more severe cases where other causes of metabolic acidosis coexist. Abbreviation: S.I.T. = salbutamol inhalation therapy