Acute kidney injury (AKI) in Pre and post treatment of 0.9% Sodium Chloride solution in pediatric shock in tertiary center

Abstract

Background: Pediatric Advanced Life Support (PALS) guideline was recommended administration of large volume intravenous crystalloid solution for treatment of pediatric shock. From other study1 found that incidence of acute kidney injury (AKI) and hyperchloremic metabolic acidosis after received 0.9%NaCl, it has been used as the isotonic crystalloid of choice in treating pediatric shock for a long time due to its availability.
Objective: Primary outcome to evaluate the prevalence of AKI in pediatric shock patients that received large volume of 0.9%NaCl within 48 h. Secondary outcomes to evaluate the prevalence of electrolytes imbalance in pediatric shock patients that received large volume of 0.9%NaCl and mortality rate. Materials and Methods: Thirty pediatric shock patients age 3 months to 15 years old, which received large volume of 0.9%NaCl since 2015 to December 2021, were included in our study. Baseline characteristics and laboratory data: electrolytes data and renal function test at 0, 24 and 48 h after resuscitation were recorded.
Results: The prevalence of AKI was statistically significant decreased from 0 h (60%), 24h (23.3%)(p=0.003) and 48 h (16.7%)(p<0.001).The prevalence of hypokalemia and hyperchloremia at 24 h was significantly increased (p=0.008), (p<0.001) respectively. The mortality rate was 16.7%, four were diagnosed septic shock with three had hematologic malignancy as an underlying disease.
Conclusion: The prevalence of AKI in pediatric shock patients decreased after receiving 0.9% NaCl iv resuscitation at 24 and 48 h. Electrolytes imbalance such as hyperchloremia and hypokalemia could be found. Patients with underlying hematologic malignancy had higher mortality rate than other pediatric patients.