Comparison Between Oral Rehydration and Intravenous Fluid Therapy Among Children under 5 Years with Acute Diarrhea with some Dehydration in the Emergency Department of the Children’s Hospital, Vientiane, Lao PDR / Lao Medical Journal

Background@#Worldwide, diarrhea is a common disease in children and is a problem that causes many children to become sick and die. Diarrhea is found to be the leading cause of death of children under 5 years of age, with 700,000 cases per year worldwide. The incidence of diarrhea is increasing in Laos.@*Objective@#To study oral rehydration and intravenous fluid therapy in children under 5 years of age with acute diarrhea with some dehydration in the Emergency Department of the Children’s Hospital, Vientiane, Lao PDR.@*Methodology@#This was cross-sectional descriptive study; data were collected by using questionnaire interview by doctors. The data entered by Epi-data with analysis by SPSS.@*Results@#Among 90 participants it was found that anxiety or irritability, sunken eyes, nausea, vomiting and flatulence were statistically significantly associated with outcome of treatment (p-value <0.05). More than half of the patients are male (52.2%), aged between 1-2 years and most (83.3%) had normal BMI values. In addition, 44.4% had a history of diarrhea for 2 days with 4 to 5 times a day in 34.4% and stools were watery in 57.8%. A number of participants (47.8%) had a history of previous diarrhea before the current illness and most of them had had it 3 times a year (41.9%). When comparing between oral rehydration and intravenous fluid therapy it was found that the children had no symptoms of anxiety or irritable (in 97.8% vs 77.8%), children with sunken eyes (in 91.1% vs 71.1%), children with vomiting (in 100% vs 64.4%) and children with flatulence (in 97.8% vs 80.0%). Excessive thirst and decreased skin turgor were not statistically different between before and after rehydration therapy (p-value >0.05).@*Conclusion@#The outcome of treatment with intravenous fluids was better than oral rehydration since former decreased vomiting, shortened hospital stays, lowered the costs and increase more parents ‘satisfaction. The oral dehydration therapy often increased the symptoms of flatulence.

Avaliação comparativa entre diferentes modalidades de reposição hidroeletrolítica em equinos desidratados experimentalmente pela utilização de parâmetros do exame físico e marcadores hematológicos / Comparative evaluation between different kinds of hydroeletrolitic reposition in horses experimentally dehydrated by the use of physical examination parameters and hematological markers

O objetivo do presente estudo foi realizar a comparação entre três modalidades de terapias hidroeletrolíticas, sendo uma hipotônica (SeHIPO) e outra isotônica (SeISO), ambas por via enteral em fluxo contínuo (HETfc), com a solução de ringer lactato por via intravenosa (RL IV), na taxa de infusão de 15 ml/kg/h, administradas simultaneamente em tempo real por 8 horas num delineamento crossover6X3 em equinos desidratados experimentalmente pela utilização de parâmetros clínicos do exame físico e de alguns exames laboratoriais. Para tanto foram utilizadas 6 éguas adultas da raça Brasileiro de Hipismo submetidas a um protocolo experimental de indução de desidratação (PD) e posteriormente tratadas de acordo com o delineamento experimental. Os resultados obtidos demonstraram que ambos os tratamentos HETfc demonstraram eficácia equivalente ao RL IV na reversão dos efeitos determinados pelo PD, ainda que para os marcadores da volemia, tais como o Volume Globular (VG), Proteínas Plasmáticas Totais (PPT) e porcentagem de Volume Plasmático (%VP) tenham sido relativamente mais lentos. Porém, para os demais marcadores clínicos a eficácia entre as três terapias estudadas foi equivalente. Esses resultados comprovam a ação das terapias HETfc ao serem comparadas ao tratamento RL IV, pela utilização dos marcadores clínicos e laboratoriais utilizados, e justificam a indicação e utilização dessas modalidades terapêuticas em equinos.

The objective of the present study was to compare three modalities of hydroelectrolytic therapies, one hypotonic (SeHIPO) and another isotonic (SeISO), both by continuous enteral flow (HETfc), with intravenous lactated ringer solution ( RL IV), at the infusion rate of 15 ml / kg / h, administered simultaneously in real time for 8 hours in a 6X3 crossover design in horses experimentally dehydrated by the use of clinical parameters of the physical examination and some laboratory tests. Six adult mares of the Brazilian Equestrian race were submitted to an experimental protocol for induction of dehydration (PD) and later treated according to the experimental design. The results showed that both HETfc treatments demonstrated an efficacy equivalent to RL IV in the reversal of the effects determined by PD, although for volume markers such as Globular Volume (VG), Total Plasma Proteins (PPT) and Percentage of Plasmatic Volume (% VP) were relatively slower. However, for the other clinical markers the efficacy among the three therapies studied was equivalent. These results confirm the action of HETfc therapies when compared to RL IV treatment, by the clinical and laboratorial markes used, and justify the indication and use of these therapeutic modalities in horses.

Avaliação comparativa entre diferentes modalidades de reposição hidroeletrolítica em equinos desidratados experimentalmente pela utilização de parâmetros do exame físico e marcadores hematológicos / Comparative evaluation between different kinds of hydroeletrolitic reposition in horses experimentally dehydrated by the use of physical examination parameters and hematological markers

O objetivo do presente estudo foi realizar a comparação entre três modalidades de terapias hidroeletrolíticas, sendo umahipotônica (SeHIPO) e outra isotônica (SeISO), ambas por via enteral em fluxo contínuo (HETfc), com a solução de ringer lactatopor via intravenosa (RL IV), na taxa de infusão de 15 ml/kg/h, administradas simultaneamente em tempo real por 8 horas numdelineamento crossover 6X3 em equinos desidratados experimentalmente pela utilização de parâmetros clínicos do exame físicoe de alguns exames laboratoriais. Para tanto foram utilizadas 6 éguas adultas da raça Brasileiro de Hipismo submetidas a umprotocolo experimental de indução de desidratação (PD) e posteriormente tratadas de acordo com o delineamento experimental.Os resultados obtidos demonstraram que ambos os tratamentos HETfc demonstraram eficácia equivalente ao RL IV na reversãodos efeitos determinados pelo PD, ainda que para os marcadores da volemia, tais como o Volume Globular (VG), ProteínasPlasmáticas Totais (PPT) e porcentagem de Volume Plasmático (%VP) tenham sido relativamente mais lentos. Porém, para osdemais marcadores clínicos a eficácia entre as três terapias estudadas foi equivalente. Esses resultados comprovam a ação dasterapias HETfc ao serem comparadas ao tratamento RL IV, pela utilização dos marcadores clínicos e laboratoriais utilizados, ejustificam a indicação e utilização dessas modalidades terapêuticas em equinos.

The objective of the present study was to compare three modalities of hydroelectrolytic therapies, one hypotonic (SeHIPO) andanother isotonic (SeISO), both by continuous enteral flow (HETfc), with intravenous lactated ringer solution ( RL IV), at the infusionrate of 15 ml / kg / h, administered simultaneously in real time for 8 hours in a 6X3 crossover design in horses experimentallydehydrated by the use of clinical parameters of the physical examination and some laboratory tests. Six adult mares of the BrazilianEquestrian race were submitted to an experimental protocol for induction of dehydration (PD) and later treated according to theexperimental design. The results showed that both HETfc treatments demonstrated an efficacy equivalent to RL IV in the reversalof the effects determined by PD, although for volume markers such as Globular Volume (VG), Total Plasma Proteins (PPT) andPercentage of Plasmatic Volume (% VP) were relatively slower. However, for the other clinical markers the efficacy among thethree therapies studied was equivalent. These results confirm the action of HETfc therapies when compared to RL IV treatment,by the clinical and laboratorial markes used, and justify the indication and use of these therapeutic modalities in horses.

A retrospective cohort study in a university hospital evaluating the effect of maternal glucose containing intravenous fluid in neonatal glycemia

@#Abstract Maternal hyperglycemia during the peripartum period is highly correlated with fetal hyperinsulinemia and consequent neonatal hypoglycemia. Liberal use of intravenous glucose therapy prior to delivery can potentially cause maternal hyperglycemia, therefore, it is prudent to implement all preventive measures. This study aims to determine the occurrence of neonatal hypoglycemia with intravenous glucose therapy prior to delivery in maternal diabetes mellitus. This was a retrospective cohort study of neonates born from diabetic mothers at the University of Santo Tomas Hospital Clinical and Private Divisions from January 1, 2013 to December 15, 2017. Clinical information gathered was divided into maternal and neonatal characteristics. Maternal intravenous fl uid use, rate, and duration were noted; maternal and neonatal blood glucose results were obtained. There were 109 infants of diabetic mothers, of which 105 were delivered as singleton and 4 from twin pregnancies. Neonatal hypoglycemia was present in 14.68%. Comparing the risk factors, there was a higher amount of glucose infused to the mothers whose offspring developed hypoglycemia compared to those without hypoglycemia. Statistically, this did not demonstrate a signifi cant difference. The rate of glucose infusion and frequency of maternal insulin use were similar between the groups. Linear correlation was not evident when the total glucose infused and the rate of intravenous glucose infusion was compared to the neonatal glucose in the fi rst hour of life. Based on this study, routine administration of glucose-containing intravenous fl uid did not infl uence the incidence of neonatal hypoglycemia. It is recommended that further prospective studies be conducted.

Hiponatremia adquirida en el hospital: ¿influye el tipo de fluidoterapia en los niños ingresados a cuidados intensivos? / Hospital-acquired hyponatremia: Does the type of fluid therapy affect children admitted to intensive care?

Resumen: Introducción: Este estudio tuvo por objetivo valorar las diferencias entre el tipo de fluidoterapia ini cial utilizada (sueros isotónicos o hipotónicos) en el desarrollo de hiponatremia, valores de cloro y to lerancia de las vías venosas. Pacientes y Método: Estudio retrospectivo de cohortes en una Unidad de Cuidados Intensivos Pediátricos (UCIP) de un hospital terciario. Se incluyeron niños menores de 15 años ingresados durante el primer semestre de los años 2010 y 2013, que recibieron fluidoterapia in travenosa, excluyéndose los sometidos a cirugía cardiaca, trasplantados renales y aquellos con ingreso inferior a 24 h. Se recogieron datos epidemiológicos, de comorbilidad y relacionados con el ingreso, tipo de suero recibido, valores de sodio y cloro en las primeras 72 h y la incidencia de extravasaciones de vías periféricas. Resultados: Se incluyeron 111 niños: 68 (61,3%) recibieron líquidos hipotónicos y 43 (38,7%) isotónicos. No hubo diferencias respecto a la patología y gravedad, ni tampoco en el volumen de líquidos recibido. Entre los pacientes que recibieron sueros hipotónicos, 28 (41,2%) pre sentaron hiponatremia, siendo esta moderada (Na <130 mEq/kg) en 11 de ellos, en comparación con 8 niños (18,6%) entre los que recibieron sueros isotónicos, registrando hiponatremia moderada solo en un caso (p=0,027). No se registró ningún caso de hipernatremia, ni hubo diferencias en los valores de cloro plasmático. Tampoco se objetivó mayor frecuencia de pérdida del acceso venoso utilizando la fluidoterapia isotónica (4,7% vs. 7,4%, p=0,704). Conclusión: El uso de líquidos iniciales isotóni cos en niños hospitalizados en UCIP se asocia con menor incidencia y gravedad de hiponatremia, sin cambio en la cloremia y es bien tolerado por las vías venosas periféricas.

Abstract: Introduction: The objective of this study was to evaluate the association between the type of initial fluid therapy used (isotonic or hypotonic solutions) and the development of hyponatremia, the plas ma chlorine values and the tolerance of venous access. Patients and Method: Retrospective cohort study in a Pediatric Intensive Care Unit (PICU) of a high complexity hospital. There were included children younger than 15 years old hospitalized during the first semester of 2010 and 2013 who recei ved intravenous maintenance fluid therapy, excluding patients undergoing cardiac surgery, kidney transplant and admissions that lasted less than 24 hours. Epidemiological, comorbidity and admis sion-related data were collected, including type of solution received, sodium and chlorine values in the first 72 hours of hospitalization and the incidence of extravasation of peripheral intravenous lines. Results: 111 children were included; 68 children (61.3%) were treated with hypotonic solutions and 43 (38.7%) with isotonic solutions. There were no differences in pathology and severity, and also in the volume of fluid received. Among the patients who received hypotonic solutions, 28 (41.2%) de veloped hyponatremia, wich was moderate (Na <130 mEq/Kg) in 11 cases, compared with 8 children (18.6%) who received isotonic solutions, with only one case of moderate hyponatremia (p = 0.027). No cases of hypernatremia were recorded, and there were no differences in plasma chlorine values. There was also no increased frequency of venous access loss in patients treated with isotonic solutions (4.7% versus 7.4%, p = 0.704). Conclusion: Treatment with initial isotonic solutions in children hos pitalized in PICU is associated with a lower incidence and severity of hyponatremia, without changes in the plasma chlorine values and it is well tolerated by peripheral intravenous lines.

Intravenous fluid selection rationales in acute clinical management / 世界急诊医学杂志（英文）

BACKGROUND:Intravenous fluid (IVF) is commonly used in acute clinical management. This study aimed to review the choice and primary considerations in IVF prescriptions and to evaluate the adequacy of guidelines and trainings on it in the New Territories West Cluster (NTWC) of Hong Kong. METHODS:This is a descriptive study based on data collected from an online survey. Data were processed by SPSS for statistical analysis. This study focused on a general description and doctor-nurse between group comparison. Participants were asked the choice of IVF for nine acute clinical scenarios and provide reason. A 1–10 scale was used to assess the sufficiency of guideline, training and information, and time for revision on IVF prescription. RESULTS:0.9％ sodium chloride was the most familiar IVF (36％), followed by 5％ Dextrose solution (26％). In the nine scenarios, the most chosen IVF was 0.9％ sodium chloride (37％–61％). There was significant difference in the choice of IVF between doctors and nurses in 7 cases. The second most chosen IVF for doctors was Plasma-Lyte A while that for nurses was Gelofusine. Departmental practice was the most chosen reason to account for the prescription. The adequacy of guideline, information and training, and time for revision was rated 5. Doctors had significantly more time at work than nurses to update knowledge in IVF prescription (5.41 versus 4.57). CONCLUSION:0.9％ sodium chloride was mostly chosen. The choice of IVF was mainly based on departmental practice. Adequacy of guideline, information and training, and time for revision on IVF prescription were average, indicating significant training deficit.

Mega Acer Kit® is more effective for warming the intravenous fluid than Ranger™ and ThermoSens® at 440 ml/h of infusion rate: an experimental performance study / 대한마취과학회지

BACKGROUND: Few studies have investigated the effectiveness of intravenous fluid warmers at low and moderate flow rates below 1,000 ml/h. In this study, we compared the effectiveness of three different fluid warmers at a low flow rate (440 ml/h). METHODS: We experimentally investigated the fluid warming performances of Mega Acer Kit® (Group M, n = 10), Ranger™ (Group R, n = 10), and ThermoSens® (Group T, n = 10) at 440 ml/h for 60 min. All devices were set at a warming temperature of 41℃ with preheating for 10 min. Intravenous fluids were then delivered through them. The fluid temperature (primary endpoint) was measured at 76 cm from the device after infusion for 60 min. The expected decrease in mean body temperature (secondary endpoint) after 5 h infusion for a 70 kg patient (ΔMBT5) was also calculated. RESULTS: The fluid temperature (mean [95% CI]) at 76 cm from the device, 60 minutes after the infusion was higher in group M (36.01 [35.73–36.29]℃), compared to groups T (29.81 [29.38–30.24]℃) and R (29.12 [28.52–29.72]℃) (P < 0.001). The ΔMBT5 (mean [95% CI]) was significantly smaller in group M (−0.04 [−0.04 to −0.03]℃) than that in groups T (−0.27 [−0.28 to −0.29]℃; P < 0.001) and R (−0.30 [−0.32 to −0.27]℃; P < 0.001). However, none of the fluid warmers provided a constant normothermic temperature above 36.5℃. CONCLUSIONS: Mega Acer Kit® was more effective in warming the intravenous fluid with the smallest expected change in the mean body temperature, compared to Ranger™ and ThermoSens®, at a flow rate of 440 ml/h.

The Role of Oliguria and the Absence of Fluid Administration and Balance Information in Illness Severity Scores / 대한구급학회지

Urinary examination has formed part of patient assessment since the earliest days of medicine. Current definitions of oliguria are essentially arbitrary, but duration and intensity of oliguria have been associated with an increased risk of mortality, and this risk is not completely attributable to the development of concomitant acute kidney injury (AKI) as defined by changes in serum creatinine concentration. The increased risk of death associated with the development of AKI itself may be modified by directly or indirectly by progressive fluid accumulation, due to reduced elimination and increased fluid administration. None of the currently extant major illness severity scoring systems or outcome prediction models use modern definitions of AKI or oliguria, or any values representative of fluid volumes variables. Even if a direct relationship with mortality is not observed, then it is possible that fluid balance or fluid volume variables mediate the relationship between illness severity and mortality in the renal and respiratory physiological domains. Fluid administration and fluid balance may then be an important, easily modifiable therapeutic target for future investigation. These relationships require exploration in large datasets before being prospectively validated in groups of critically ill patients from differing jurisdictions to improve prognostication and mortality prediction.

The Role of Oliguria and the Absence of Fluid Administration and Balance Information in Illness Severity Scores / 대한중환자의학회지

Urinary examination has formed part of patient assessment since the earliest days of medicine. Current definitions of oliguria are essentially arbitrary, but duration and intensity of oliguria have been associated with an increased risk of mortality, and this risk is not completely attributable to the development of concomitant acute kidney injury (AKI) as defined by changes in serum creatinine concentration. The increased risk of death associated with the development of AKI itself may be modified by directly or indirectly by progressive fluid accumulation, due to reduced elimination and increased fluid administration. None of the currently extant major illness severity scoring systems or outcome prediction models use modern definitions of AKI or oliguria, or any values representative of fluid volumes variables. Even if a direct relationship with mortality is not observed, then it is possible that fluid balance or fluid volume variables mediate the relationship between illness severity and mortality in the renal and respiratory physiological domains. Fluid administration and fluid balance may then be an important, easily modifiable therapeutic target for future investigation. These relationships require exploration in large datasets before being prospectively validated in groups of critically ill patients from differing jurisdictions to improve prognostication and mortality prediction.

Dengue With Severe Plasma Leakage: A New Monitoring Approach / Dengue con extravasación grave de plasma: un nuevo abordaje de evaluación

Abstract:AimTo describe a simple and efficacious monitoring system for patients presenting with severe dengue with severe plasma leakage.Method: We reviewed sixty-one out of 110 records of patients presenting with dengue in August and September of 1999 at the Hospital Tony Facio, Limón province, Costa Rica.Results: Dengue virus 3 was the cause of the epidemic. Thirty one (51%) patients presented with warning sings, and thirty (49%) had severe dengue with severe plasma leakage. Those patients presenting with hypotension (low mean arterial blood pressure) were treated with an intravenous polyelectrolyte solution in order to maintain the mean arterial pressure between the lower and mean range. When the mean arterial pressure presented a tendency to rise over the normal range, the infusion was withdrawn. The hematocrit was not the parameter used to monitor the treatment of the patients. There were no deaths.Conclusions: Monitoring the mean arterial blood pressure instead of the hematocrit values in patients with severe dengue with severe plasma leakage represents an easier and more efficacious way of treating this patient population.

Resumen:Objetivo:describir un sistema de monitoreo más simple y eficiente para pacientes con dengue grave con extravasación de plasma severa.Método:se revisaron 61 de 110 expedientes de pacientes que presentaban dengue, entre agosto y setiembre de 1999, en el Hospital Tony Facio de la provincia de Limón en Costa Rica.Resultados:el virus de dengue tipo 3 causó la epidemia. Treinta y uno (51%) de los pacientes presentaron signos de alarma, treinta (49%) presentaron dengue grave con extravasación de plasma severa. Los pacientes que presentaban hipotensión (baja presión sanguínea media) fueron tratados con solución de polielectrolitos intravenosa para mantener la presión arterial media entre el rango inferior y la media. En cuanto la presión arterial media presentaba una tendencia a incrementar sobre el rango normal, la infusión era retirada. El hematocrito no fue un parámetro para monitorear el manejo de los pacientes. No hubo muertes.Conclusiones:El monitorear la presión arterial media, en lugar de los valores de hematocritos, en pacientes con dengue grave con extravasación severa representa una manera más fácil y eficiente de tratar a esta población de pacientes.

The Complexities of Intravenous Fluid Research: Questions of Scale, Volume, and Accumulation / 대한구급학회지

Despite near ubiquity, information regarding fluids consumption at a health care systems level, and patient exposure at an individual level, is surprisingly limited in the medical literature. The epidemiology of the foundational medical intervention of intravenous fluid administration is incredibly complex, with millions of patients being exposed internationally every year. Fluid is being given for different reasons, to different targets, following different triggers, by different specialties in different countries, and any observations that can be made are thought to have limited external validity to other jurisdictions and patient groups. The independent effects of fluid administration and fluid accumulation are very hard to separate from other markers of illness severity and aspects of the process of care. Fluid accumulation can result in organ injury, even when the fluid is being given to purportedly ameliorate or prevent such injury, and if it were independently associated with mortality then would be an easily accessible and modifiable risk factor for subsequent morbidity or death. Despite their ubiquity, it is clear that we have limited understanding of the effects of the intravenous fluids we use daily in the most vulnerable of patient groups. The research agenda in this field is large and urgent.

The Complexities of Intravenous Fluid Research: Questions of Scale, Volume, and Accumulation / 대한중환자의학회지

Despite near ubiquity, information regarding fluids consumption at a health care systems level, and patient exposure at an individual level, is surprisingly limited in the medical literature. The epidemiology of the foundational medical intervention of intravenous fluid administration is incredibly complex, with millions of patients being exposed internationally every year. Fluid is being given for different reasons, to different targets, following different triggers, by different specialties in different countries, and any observations that can be made are thought to have limited external validity to other jurisdictions and patient groups. The independent effects of fluid administration and fluid accumulation are very hard to separate from other markers of illness severity and aspects of the process of care. Fluid accumulation can result in organ injury, even when the fluid is being given to purportedly ameliorate or prevent such injury, and if it were independently associated with mortality then would be an easily accessible and modifiable risk factor for subsequent morbidity or death. Despite their ubiquity, it is clear that we have limited understanding of the effects of the intravenous fluids we use daily in the most vulnerable of patient groups. The research agenda in this field is large and urgent.

Ringer’s Lactate vs Normal Saline for Children with Acute Diarrhea and Severe Dehydration: A Double Blind Randomized Controlled Trial.

Objective: WHO recommends Ringer’s lactate (RL) and Normal Saline (NS) for rapid intravenous rehydration in childhood diarrhea and severe dehydration. We compared these two fluids for improvement in pH over baseline during rapid intravenous rehydration in children with acute diarrhea. Design: Double-blind randomized controlled trial Setting: Pediatric emergency facilities at a tertiary-care referral hospital. Intervention: Children with acute diarrhea and severe dehydration received either RL (RL-group) or NS (NS-group), 100 mL/kg over three or six hours. Children were reassessed after three or six hours. Rapid rehydration was repeated if severe dehydration persisted. Blood gas was done at baseline and repeated after signs of severe dehydration disappeared. Outcome Measures: Primary outcome was change in pH from baseline. Secondary outcomes included changes in serum R E S E A R C H P A P E R INDIAN PEDIATRICS 963 VOLUME 49__DECEMBER 16, 2012 electrolytes, bicarbonate levels, and base-deficit from baseline; mortality, duration of hospital stay, and fluids requirement. Results: Twenty two children, 11 each were randomized to the two study groups. At primary end point (disappearance of signs of severe dehydration), the improvement in pH from baseline was not significant in RL-group [from 7.17 (0.11) to 7.28 (0.09)] as compared to NS-group [7.09 (0.11) to 7.21 (0.09)], P=0.17 (after adjusting for baseline serum Na/ Cl). Among this limited sample size, children in RL group required less fluids [median 310 vs 530 mL/kg, P=0.01] and had shorter median hospital stay [38 vs 51 hours, P=0.03]. Conclusions: There was no difference in improvement in pH over baseline between RL and NS among children with acute diarrhea and severe dehydration.

Audit on intravenous fluid in children at a teaching hospital in North East England.

Objectives: To compare the current practice of intravenous fluid regime usage in children from one month to 16 years at University Hospital of North Tees and University Hospital of Hartlepool against local guideline developed using National Patient Safety Agency (NPSA) guideline. A subsidiary objective was to identify desirable changes that need to be done to the existing system. Method: E-discharge letters were perused from 1st January to 31st December 2009. Children who received intravenous fluid were taken and detailed discharge letters were screened. A pretested proforma was used to audit the discharge notes. Results: During the one year period 62 patients were included. Fifty two percent were males. Twenty eight children were less than one year old, 24 between 1-5 years, 6 between 6-10 years and 4 more than 10 years old. Complete clinical data to assess dehydration was not recorded according to audit standard in any of the patients. Clinical diagnoses were gastroenteritis in 14, viral illness in 10, bronchiolitis in 8 and pyloric stenosis in 6. Mild dehydration was noted in 52, moderate dehydration in 4 and severe dehydration in 2. Compliance on the guideline was audited during different stages of management. Forty percent guideline compliance was achieved during immediate resuscitation, 71% during maintenance fluid, 50% during fluid deficit correction, 0% during replacement of on-going losses, 78% during monitoring of electrolytes and 6% during monitoring of fluid balance. Conclusion: This audit showed that audit standards were not achieved at different levels of management.

Fluid therapy: classification and characteristics of intravenous fluids

Fluid and electrolyte therapies including nutritional support are markedly developing in medicine and many kinds of commercial fluids are being introduced to clinical practice. Understanding the characteristics and usefulness of intravenous fluids is necessary to manage patients properly. Disputes about the usefulness of crystalloid or colloid solutions for specific clinical conditions still continue. To make ideal fluid therapy possible, many kinds of fluids will be developed and applied to clinical practice in the near future by mimicking the composition and functions of human body fluids. The selection of crystalloid and colloid solutions for fluid therapy should be performed by considering patients' clinical and pathophysiological conditions and the characteristics and usefulness of each intravenous fluid.

Epidemic Investigation of Pyrogenic Reactions caused by Contaminated Intravenous Products / 병원감염관리

PURPOSE: This study was conducted to investigate the epidemic pyrogenic reactions that occurred hospital-widely in 51 patients on 30-31 Mar. 1995 at a tertiary, educational, and acute care hospital. METHODS: The remained intravenous (IV) drugs and IV fluids that were infused to patients (N=51) who developed pyrogenic reactions were cultured and tested pyrogenic matter. Pyrogenic test was done by Limulus Amebocyte Lysate (PyrotellRMA,USA). RESULTS: IV normal saline 50 cc bottles (AAXSAT and AAX5AV) those were collected being used from case patients, and new bottles stocked in the drug storage were positive to pyrogenic test. Used normal saline collected from case patients were cultured coagulase-negative Staphylococus. Moreover the company, manufacturer of these fluids reported the positive pyrogenic test on these IV fluids (AAXSAT and AAX5AV). CONCLUSION: This epidemic was a pyrogenic reaction for infused the intrinsic contaminated fluid with pyrogen. We could prevent not the additional pyrogenic reactions in study hospital but national wide epidemics to apply the rapid and well-designed epidemic investigation and infection control.

Report of Intravenous Fluid Contamination Originated from Rubber Caps: A Study of Contamination Routes of Intravenous Fluid / 병원감염관리

BACKGROUND: Nosocomial septicemia associated with contamination of infusate occurs infrequently. Three patients in a university hospital developed fever that was suspected to be infusion-related. These patients were receiving Hartman's solutions that were found to be contaminated by Klebsiella oxytoca, Pseudomonas species, and Citrobacter species. We evaluated the contamination routes of infusates. METHODS: Samples for culture were collected from used intravenous fluids and unused fluids, and the top of rubber caps were swapped. These were cultured in trypticase soy broth and blood agar plate. RESULTS: Cultures of used intravenous fluids showed that five of 33 fluids were contaminated by bacteria, and cultures of unused fluids yielded no microorganism. We suspected that contamination of the fluids developed during insertion of administration set, especially from top of the caps. Cultures of the caps disclosed that 26 of 40 caps were contaminated, and contamination rate was higher when caps had been moistured with water. After disinfection with 70% alcohol, culture positive rate of the rubber caps was reduced to 15.0% (6/40). Of the fluids which had standed for seven hours with administration set inserted, four were culture-positive, and two of them showed same organism obtained from their caps. CONCLUSIONS: The results of this study suggest that the rubber cap can be the source of contamination of IV fluids.

Report of Intravenous Fluid Contamination Originated from Rubber Caps: A Study of Contamination Routes of Intravenous Fluid / 병원감염관리

BACKGROUND: Nosocomial septicemia associated with contamination of infusate occurs infrequently. Three patients in a university hospital developed fever that was suspected to be infusion-related. These patients were receiving Hartman's solutions that were found to be contaminated by Klebsiella oxytoca, Pseudomonas species, and Citrobacter species. We evaluated the contamination routes of infusates. METHODS: Samples for culture were collected from used intravenous fluids and unused fluids, and the top of rubber caps were swapped. These were cultured in trypticase soy broth and blood agar plate. RESULTS: Cultures of used intravenous fluids showed that five of 33 fluids were contaminated by bacteria, and cultures of unused fluids yielded no microorganism. We suspected that contamination of the fluids developed during insertion of administration set, especially from top of the caps. Cultures of the caps disclosed that 26 of 40 caps were contaminated, and contamination rate was higher when caps had been moistured with water. After disinfection with 70% alcohol, culture positive rate of the rubber caps was reduced to 15.0% (6/40). Of the fluids which had standed for seven hours with administration set inserted, four were culture-positive, and two of them showed same organism obtained from their caps. CONCLUSIONS: The results of this study suggest that the rubber cap can be the source of contamination of IV fluids.

Experimental Study of Early Intravenous Fluid Infusion in Dogs with Combined Burn-Blast Injuries / 第三军医大学学报

How to use intravenous fluid therapy safely in patients with combined burn-blast injuries is an unsolved problem. Therefore, this experimental study was carried out in 64 dogs with combined injuries of 40% second degree burns (inflicted with nalpam) and moderate or severe blast injury (inflicted with TNT charge explosion) . Intravenous infusion was administered as early as 6-8 hours after injury. The amount was 0.5 ml colloid and 1-1.5 ml crystal solution/kg of body weight/one percent of body surface burns in the first 24 hours after injury, and a half of this amount was given in the second 24 hours. The transfusion of the fluid was finished within 3-5 hours. Another amount 30% of the total amount of the fluid intravenously infused was added as drinking water.It was found that there was no significant difference between the infused animals and the controls so far as the pulmonary pathological changes (including pulmonary edema) were concerned. It is believed that a reasonable amount of intravenous fluid can be safely given to patients with combined burn-blast injuries provided that the changes of the urinary output and the physical signs of the chest are carefully monitored.