Frustration

We had a tutorial on paediatric fluid prescribing/administration the other day which was extremely useful, but it reminded me of how I'd managed to miss out on providing the guidelines pre-SAQ paper that were issued by the NPSA on fluid management of paediatric patients. I thought I'd covered all of them in a previous entry, and it was typical that the one that escaped came up in the SAQ paper. So, apologies for the tardiness but here they are:

Reducing the risk of hyponatraemia when administering intravenous infusions to children NPSA March 2007

-Since 2000, there have been four child deaths following neurological injury from hospital-acquired hyponatraemia reported in the UK.

Recommendations
-Remove 0.18% NaCl with glucose 4% from stocks & general use in areas treating children.
-Produce local clinical guidelines for the fluid management of paediatric patients.
-Provide adequate supervision and training for all staff involced in the prescribing, monitoring, and administering of IV fluids for children.
-Review & improve design of existing drug prescription/fluid balance charts.
-Promote reporting of hospital-acquired hyponatraemia incidents

Resuscitation: intravascular volume depletion should be managed with 0.9% NaCl boluses
Deficit: estimate fluid deficit & replace as 0.9% NaCl with 5% dextrose or 0.9% NaCl over a minimum of 24hrs
Maintenance: do not use 0.18% NaCl with glucose 4%

The majority of children may be managed with 0.45% NaCl with 5% glucose (or 2.5% glucose)

So there - I've outed my demon!

There are also some new relevant NICE guidelines:

-April 2008: Management of Inadvertent Perioperative Hypothermia
-March 2008: Prophylaxis against Infective Endocarditis