title: Sodium administration in critically ill paediatric patients in Australia and New Zealand: a multicentre point prevalence study.
abstract: OBJECTIVE
  Dysnatraemia and a positive fluid balance are associated with poor outcomes in paediatric intensive care units (PICUs). Our objective was to determine sodium intake and the total daily fluid balance in children in the PICU.
  
  
  METHODS
  A single-day point prevalence study in 10 Australian and New Zealand PICUs. Patients on free oral diets were excluded. Demographics, 24-hour fluid balance and sodium intake (enteral and parenteral sources) were recorded.
  
  
  RESULTS
  We enrolled 65 patients; 15 were excluded due to having a free oral intake and two patients had incomplete data, leaving 48 children in the study cohort. The 21 infants had a median age of 4 months (interquartile range [IQR], 1-7 months) and a median bodyweight of 5 kg (IQR, 3.5- 6.1 kg). The 27 children > 1 year had a median age of 3 years (IQR, 1.5-13 years) and a median bodyweight of 17 kg (IQR, 9.5-47.5 kg). Overall, the median sodium administration on the study day was 4.9mmol/kg (IQR, 3.2- 8mmol/kg), median fluid administration was 80.8mL/kg (IQR, 49.8-111.4mL/kg) and median fluid balance was 9mL/kg (IQR, -1.4 to 41 mL/kg). For infants, the median sodium administration was 6mmol/kg (IQR, 3.9-8.1mmol/ kg), and median fluid balance was 20.8mL/kg (IQR, 3.5- 47.2mL/kg). For children > 1 year, the median sodium administration was 3.5mmol/kg (IQR, 3.1-7.8mmol/kg), and median fluid balance was 5.3mL/kg (IQR, -2.7 to 17.7mL/kg). Overall, fluid infusions, boluses and catheter flushes together contributed 46.2% of total sodium administered. Drugs contributed substantially to administered sodium (33.3%), with antibiotics accounting for the majority. Enteral feeds contributed 16.2% to overall administered sodium, and were the major source in patients in the PICU for > 10 days.
  
  
  CONCLUSIONS
  Daily sodium intake in children in the PICU is high. The contributions of maintenance and bolus intravenous fluids (most commonly as 0.9% sodium chloride), drug infusions and boluses, including antibiotics, and enteral feeds, are significant.
authors.affiliation: Department of Critical Care Medicine, Flinders University, Adelaide, SA, Australia. biharishailesh@gmail.com.
authors.forename: Shailesh
authors.initials: S
authors.lastname: Bihari
authors.affiliation: Kids Research Institute, Children's Hospital at Westmead, Sydney, NSW, Australia.
authors.forename: Marino
authors.initials: M
authors.lastname: Festa
authors.affiliation: School of Medicine, University of Adelaide, Adelaide, SA, Australia.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Peake
authors.affiliation: Department of Intensive Care Medicine, Nepean Hospital, Sydney, NSW, Australia.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Seppelt
authors.affiliation: School of Medicine, University of Adelaide, Adelaide, SA, Australia.
authors.forename: Patricia
authors.initials: P
authors.lastname: Williams
authors.affiliation: Children's Hospital at Westmead, Sydney, NSW, Australia.
authors.forename: Barry
authors.initials: B
authors.lastname: Wilkins
authors.affiliation: Department of Critical Care Medicine, Flinders University, Adelaide, SA, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bersten
mesh_terms: D000293:Adolescent; D001315:Australia; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009520:New Zealand; D012965:Sodium Chloride / Q000008:administration & dosage*; D014882:Water-Electrolyte Balance / Q000502:physiology*
chemical_list: D012965:Sodium Chloride