Facundo Jorro Barón

Effects on natremia of the intravenous hypotonic fluid administration in hospitalized children with acute lower respiratory tract infection

INTRODUCTION Because of the risk of developing hyponatremia, intravenous hydratation prescription in children with lower respiratory tract disease (LRTD) is challenging. OBJECTIVE To evaluate if intravenous hypotonic fluid administration in children with LRTD leads to hyponatremia. METHODS Patients aged 1 month to 18 years, hospitalized for LRTD, requiring intravenous fluids were included. Blood samples to determine sodium levels were obtained before and within the first twenty four hours of fluids administration. A serum sodium decrease >or= 4 mEq/L was considered significative. Student t test and logarithmic regression was used to analyze results (significance level p<0.05). RESULTS From 1039 patients hospitalized with LRTD (58 received intravenous fluids), 35 patients met the inclusion criteria. Median age was 3 months (1-60 months), 57.1% were males. Patients received 59.3 +/- 24 ml/h of intravenous fluids, 39.2 +/- 16 ml/h of electrolyte free water and 2 +/- 1.3 mEq/kg of sodium. Serum sodium was 141.2 mEq/l in the initial sample and 139.3 mEq/l in the second one. Mean serum sodium decrease was 1.9 +/- 4.8 mEq/l (IC 95%: 0.2-3.5; p< 0.026). Eleven patients had a sodium decrease >or=4 mEq/l, none showed clinical manifestation of hyponatremia. For each mEq/l of increase in initial natremia the odds of achieving a decrease in serum sodium >or=4 mEq/l increases in 40% (OR=1.39; IC 95%: 1.1-1.8). CONCLUSION A significant decrease in initial serum sodium has been observed in 11 of 35 patients. Higher initial serum sodium values increase the odds of a significant decrease.

Evaluation of an improvement strategy on the incidence of medication prescribing errors in a pediatric intensive care unit

UNLABELLED Medical prescribing errors (MPEs) are one of the most common causes of adverse events. Intensive care units are a high-risk setting for their occurrence. OBJECTIVES To describe the incidence and types of MPEs in our Pediatric Intensive Care Unit. To assess whether the implementation of an improvement strategy on MPEs affects their incidence in the short- and long-term. POPULATION AND METHODS Prospective, uncontrolled, before-after study. Universe and sample. All medical prescriptions for patients hospitalized in the Pediatric Intensive Care Unit of the Hospital General de Niños Pedro de Elizalde from July-December, 2013 and from July-August, 2014. RESULTS In the pre-intervention period, MPEs rate was 13.9%, the most common being the absence of the time a given medication was modified, followed by missing a dose or medication. The medication most frequently involved in MPEs was the sedation and continuous analgesia group. After the implementation of an improvement program on MPEs, the incidence decreased to 6.3 errors every 100 prescriptions. The MPE type which showed the greatest reduction was the absence of the time of modification. Except for parenteral hydration and electrolyte supplementation, the rest of the analyzed medication groups showed a marked reduction. One year after having reviewed the situation, the MPE rate was 5.8%, and values remained similar to those of the immediate postintervention period. CONCLUSION Managing an improvement program on MPEs resulted in a decrease in its incidence.