Using saline solutions for ACE washouts.
We had found that twice-normal saline (2NS) antegrade continence enema (ACE) lavages were better than with normal saline (NS) but caused unpleasant symptoms. We therefore undertook a double-blind crossover study comparing water, NS and 2NS in four children. NS produced no disturbances, but water caused a transient fall in plasma osmolality of 7.3 mosmol/kg at 20 min, and falls in urine sodium and osmolality. With 2NS, the plasma sodium rose by 2.5 mmol/l, the plasma proteins rose by 2.3 g/l and the lavage fluid sodium fell, suggesting that about 10 ml/kg of plasma water had moved into the colonic lumen, and two subjects became thirsty. Five other children did home testing. Their home-produced saline was too concentrated and varied widely, and they found that 30 ml/kg of NS produced the same washout result as 20 ml/kg of 2NS. Carefully made-up NS should be used for lavage, increasing volumes if necessary.
Hyde
S-J
SJ
Medical School, Newcastle University, Newcastle, UK.
Coulthard
M G
MG
Jaffray
B
B
Vallely
M E
ME
Harding
S M
SM
D000293:Adolescent; D002648:Child; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004733:Enema; D005242:Fecal Incontinence / Q000628:therapy*; D005260:Female; D006701:Home Nursing / Q000592:standards; D006801:Humans; D008297:Male; D009994:Osmolar Concentration; D012964:Sodium / Q000097:blood / Q000652:urine; D012965:Sodium Chloride / Q000008:administration & dosage* / Q000009:adverse effects; D007507:Therapeutic Irrigation / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D014867:Water / Q000009:adverse effects
D014867:Water; D012965:Sodium Chloride; D012964:Sodium