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Congenital Heart Disease pp 115–133Cite as

Fluid and Electrolyte Balance

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Abstract

The appropriate evaluation and maintenance of fluid and electrolyte balance in children with congenital heart disease are a fundamental aspect of everyday clinical practice. Fluids are continuously administered for the most reasons: nutrition, drug administration, and fluid resuscitation. Their amount and biochemical composition have been associated with several important outcomes in the pediatric and adult cardiac surgery populations. For example, even if human albumin and crystalloids remain the first choice for cardiopulmonary bypass priming and volume replacement, uncertainty currently concerns third-generation hydroxyethyl starches. Secondly, appropriate and timely fluid resuscitation may improve patients’ survival, but an incorrect fluid therapy in pediatric intensive care setting can significantly impact several organ functions. Hence, the fluid status assessment and management during perioperative period in pediatric cardiac surgery are a clinical challenge: there is no consensus regarding the optimal definition of fluid overload, which also varies by calculations and by the time frame during which fluid balance is assessed. Furthermore, the estimation of intravascular volume to guide fluid therapy is typically based on clinical assessment and on standard hemodynamic and perfusion parameters, but these parameters could be inadequate in children affected by congenital heart disease.

Similarly, derangements of potassium, sodium, calcium, phosphate, and magnesium (both above and below the normal range) are extremely common in this population and require strict monitoring and careful intervention.

This chapter will review the current evidence concerning perioperative fluid and electrolyte management, assessment, outcomes, and treatment in critically ill children undergoing congenital heart surgery.

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References

  1. Hanart C, Khalife M, De Ville A, et al. Perioperative volume replacement in children undergoing cardiac surgery: albumin versus hydroxyethyl starch 130/0.4. Crit Care Med. 2009;37:696–701.

    Article  CAS  PubMed  Google Scholar 

  2. Aubron C, Bellomo R. Infusion of hydroxyethyl starch-containing fluids. Minerva Anestesiol. 2013;79(9):1088–92.

    CAS  PubMed  Google Scholar 

  3. Van der Linden P, De Ville A, Hofer A, et al. Six percent hydroxyethyl starch 130/0.4 (Voluven®) versus 5% human serum albumin for volume replacement therapy during elective open-heart surgery in pediatric patients. Anesthesiologica. 2013;119:1296–309.

    Article  Google Scholar 

  4. Van der Linden P, Dumolin M, Van Lerberghe C, et al. Efficacy and safety of 6% hydroxyethyl starch 130/0.4 (Voluven) for perioperative volume replacement in children undergoing cardiac surgery: a propensity-matched analysis. Crit Care Med. 2015;19(1):87–97.

    Google Scholar 

  5. Sümpelmann R, Kretz FJ, Gäbler R, et al. Hydroxyethyl starch 130/0.42/6:1 for perioperative plasma volume replacement in children: preliminary results of a European Prospective Multicenter Observational Postauthorization Safety Study (PASS). Paediatr Anaesth. 2008;18(10):929–33.

    Article  PubMed  Google Scholar 

  6. Akkucuk FG, Kanbak M, Ayhan B, et al. The effect of HES (130/0.4) usage as the priming solution on renal function in children undergoing cardiac surgery. Ren Fail. 2013;35(2):210–5.

    Article  CAS  PubMed  Google Scholar 

  7. Carcillo JA. Intravenous fluid choices in critically ill children. Curr Opin Crit Care. 2014;20(4):396–401.

    Article  PubMed  Google Scholar 

  8. Shaw AD, Bagshaw SM, Goldstein SL, et al. Major complications, mortality, and resource utilization after open abdominal surgery: 0.9% saline compared to plasma-lyte. Ann Surg. 2012;255:821–9.

    Article  PubMed  Google Scholar 

  9. Seguin J, Albright B, Vertullo L, et al. Extent, risk factors and outcome of fluid overload after pediatric heart surgery. Crit Care Med. 2014;42(12):2591–9.

    Article  PubMed  Google Scholar 

  10. Hazle MA, Gajarski RJ, Sunkyung Y, et al. Fluid overload in infants following congenital heart surgery. Pediatr Crit Care Med. 2013;14:44–9.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hassinger AB, Wald EL, Goodman DM. Early postoperative fluid overload precedes acute kidney injury and is associated with higher morbidity in pediatric cardiac surgery patients. Pediatr Crit Care Med. 2014;15:131–8.

    Article  PubMed  Google Scholar 

  12. Sinitsky L, Walls D, Nadel S, et al. Fluid overload at 48 hours is associated with respiratory morbidity but not mortality in a general PICU: retrospective cohort study. Pediatr Crit Care Med. 2015;16:205–9.

    Article  PubMed  Google Scholar 

  13. Arikan AA, Zappitelli M, Goldstein SL, et al. Fluid overload is associated with impaired oxygenation and morbidity in critically ill children. Pediatr Crit Care Med. 2012;13:253–8.

    Article  PubMed  Google Scholar 

  14. Upadya A, Tilluckdharry L, Muhalidharan V, et al. Fluid balance and weaning outcomes. Intensive Care Med. 2005;31(12):1643–7.

    Article  PubMed  Google Scholar 

  15. Cooper DS, Costello JM, Bronicki RA, et al. Current challenges in cardiac intensive care: optimal strategies for mechanical ventilation and timing of extubation. Cardiol Young. 2008;18(Suppl 3):72–83.

    Article  PubMed  Google Scholar 

  16. Goldstein SL, Somers MJ, Baum MA, et al. Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy. Kidney Int. 2005;67:653–8.

    Article  PubMed  Google Scholar 

  17. Sutherland SM, Zappitelli M, Alexander SR, et al. Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. Am J Kidney Dis. 2010;55(2):316–25.

    Article  PubMed  Google Scholar 

  18. Bontant T, Matrot B, Abdoul H, et al. Assessing fluid balance in critically ill pediatric patients. Eur J Pediatr. 2015;174(1):133–7.

    Article  PubMed  Google Scholar 

  19. van Aspereen Y, Brand PL, Bekhof J. Reliability of the fluid balance in neonates. Acta Paediatr. 2012;101(5):479–83.

    Article  Google Scholar 

  20. Brierley J, Carcillo JA, Choong K, et al. Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Crit Care Med. 2009;37:666–88.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Foland JA, Fortenberry JD, Warshaw BL, et al. Fluid overload before continuous hemofiltration and survival in critically ill children. A retrospective analysis. Crit Care Med. 2004;32:1771–6.

    Article  PubMed  Google Scholar 

  22. Gan H, Cannesson M, Chandler JR, et al. Predicting fluid responsiveness in children: a systematic review. Anesth Analg. 2013;117:1380–92.

    Article  PubMed  Google Scholar 

  23. Byon HJ, Lim CW, Lee JH, et al. Prediction of fluid responsiveness in mechanically ventilated childen undergoing neurosurgery. Br J Anaesth. 2013;110(4):586–91.

    Article  PubMed  Google Scholar 

  24. Raux O, Spencer A, Fesseau R, et al. Intraoperative use of transesophageal Doppler to predict response to volume expansion in infants and neonates. Br J Anaesth. 2012;108(1):100–7.

    Article  CAS  PubMed  Google Scholar 

  25. Singer M, Bennett ED. Non invasive optimization of left ventricular filling using esophageal doppler. Crit Care Med. 1991;19(9):1132–7.

    Article  CAS  PubMed  Google Scholar 

  26. Tibby SM, Hatherill M, Durward A, et al. Are transesophageal Doppler parameters a reliable guide to paediatric haemodynamic status and fluid management? Intensive Care Med. 2001;27:201–5.

    Article  CAS  PubMed  Google Scholar 

  27. Renner J, Broch O, Duetschke P, et al. Prediction of fluid responsiveness in infants and neonates undergoing congenital heart surgery. Br J Anaesth. 2012;108:108–15.

    Article  CAS  PubMed  Google Scholar 

  28. Chandler JR, Cooke E, Hosking M, et al. Volume responsiveness in children, a comparison of static and dynamic variables. In: Proceedings of the IARS 2011, Annual meeting: S-200; 2011.

    Google Scholar 

  29. Pereira de Souza Neto E, Grousson S, Duflo F, et al. Predicting fluid responsiveness in mechanically ventilated children under general anesthesia using dynamic parameters and transthoracic echocardiography. Br J Anaesth. 2011;106:856–64.

    Article  CAS  PubMed  Google Scholar 

  30. Renner J, Broch O, Gruenewald M, et al. Non-invasive prediction of fluid responsiveness in infants using pleth variability index. Anaesthesia. 2011;66:582–9.

    Article  CAS  PubMed  Google Scholar 

  31. Durand P, Chevret L, Essouri S, et al. Respiratory variations in aortic blood flow predict responsiveness in ventilated children. Intensive Care Med. 2008;34:888–94.

    Article  PubMed  Google Scholar 

  32. Choi DY, Kwak HJ, Park HY, et al. Respiratory variation in aortic blood flow velocity as a predictor of fluid responsiveness in children after repair of ventricular septal defect. Pediatr Cardiol. 2010;31:1166–70.

    Article  PubMed  Google Scholar 

  33. Lee JH, No HJ, Kim HS, et al. Prediction of fluid responsiveness using a non-invasive cardiac output monitor in children undergoing cardiac surgery. Br J Anaesth. 2015;29:1–7.

    Google Scholar 

  34. Weber T, Wagner T, Neumann K, et al. Low predictability of three different noninvasive methods to determine fluid responsiveness in critically ill children. Pediatr Crit Care Med. 2015;16:e89–94.

    Article  PubMed  Google Scholar 

  35. Ricci Z, Iacoella C, Cogo P. Fluid management in critically ill pediatric patients with congenital heart disease. Minerva Pediatr. 2011;63:399–410.

    CAS  PubMed  Google Scholar 

  36. Felker GM, Kerry LL, Bull DA, et al. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med. 2011;364:797–805.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. van der Vorst MM, van Heel Ruys-Dudok I, Kist-van Holthe JE, et al. Continuous intravenous furosemide in haemodynamically unstable children after cardiac surgery. Intensive Care Med. 2001;27:711–5.

    Article  PubMed  Google Scholar 

  38. Ricci Z, Haiberger R, Pezzella C, et al. Furosemide versus ethacrynic acid in pediatric patients undergoing cardiac surgery: a randomized controlled trial. Crit Care. 2015;19:2.

    Article  PubMed  PubMed Central  Google Scholar 

  39. McCallister KM, Chhim RF, Briceno-Medina M, et al. Bumetanide continuous infusions in critically ill pediatric patients. Pediatr Crit Care Med. 2015;16:e19–22.

    Article  PubMed  Google Scholar 

  40. Goldstein S, Bagshaw S, Cecconi M, et al. Pharmacological management of fluid overload. Br J Anaesth. 2014;113:756–63.

    Article  PubMed  Google Scholar 

  41. Modem V, Thompson M, Gollhofer D, et al. Timing of continuous renal replacement therapy and mortality in critically ill children. Crit Care Med. 2014;42:943–53.

    Article  CAS  PubMed  Google Scholar 

  42. Selewski D, Cornell TT, Blatt NB, et al. Fluid overload and fluid removal in pediatric patients on extracorporeal membrane oxygenation requiring continuous renal replacement therapy. Crit Care Med. 2012;40:2694–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Forman S, Crofton P, Huang H, et al. The epidemiology of hypernatraemia in hospitalised children in Lothian: a 10-year study showing differences between dehydration, osmoregulatory dysfunction and salt poisoning. Arch Dis Child. 2012;97(6):502–7.

    Article  PubMed  Google Scholar 

  44. Fang C, Mao J, Dai Y, et al. Fluid management of hypernatraemic dehydration to prevent cerebral oedema: a retrospective case control study of 97 children in China. J Paediatr Child Health. 2010;46(6):301–3.

    Article  PubMed  Google Scholar 

  45. Choong K, Arora S, Cheng J, et al. Hypotonic versus isotonic maintenance fluids after surgery for children: a randomized controlled trial. Pediatrics. 2011;128(5):857–66.

    Article  PubMed  Google Scholar 

  46. Sterns RH, Hix JK, Silver S. Treatment of hyponatremia. Curr Opin Nephrol Hypertens. 2010;19(5):493–8.

    Article  PubMed  Google Scholar 

  47. Masilamani K, van der Voort J. The management of acute hyperkalaemia in neonates and children. Arch Dis Child. 2012;97(4):376–80.

    Article  PubMed  Google Scholar 

  48. Kim M, Somers MJG. Fluid and electrolyte physiology and therapy. In: McMillan JA, DeAngelis CD, Feigin RD, editors. Oski’s pediatrics. 4th ed. Baltimore: Lippincott Williams and Wilkins; 2006. p. 54.

    Google Scholar 

  49. Mount DB, Zandi-Nejad K. Disorders of potassium balance. In: Brenner BM, editor. Brenner and rector’s the kidney. Philadelphia: WB Saunders Co; 2008. p. 547.

    Google Scholar 

  50. Rose BD, Post TW. Hypokalemia. In: Rose BD, Post TW, editors. Clinical physiology of acid-base and electrolyte disorders. 5th ed. New York: McGraw-Hill; 2001. p. 836.

    Google Scholar 

  51. Maier JD, Levine SN. Hypercalcemia in the intensive care unit: a review of pathophysiology, diagnosis, and modern therapy. J Intensive Care Med. 2015;30(5):235–52.

    Article  PubMed  Google Scholar 

  52. Bilezikian JP. Management of acute hypercalcemia. N Engl J Med. 1992;326(18):1196–203.

    Article  CAS  PubMed  Google Scholar 

  53. Marx SJ, Bourdeau JE. Calcium metabolism. In: Maxwell MH, Kleeman CR, Narins RG, editors. Clinical disorders of fluid and electrolyte metabolism. 4th ed. New York: McGraw-Hill; 1987.

    Google Scholar 

  54. Thomas TC, Smith JM, White PC, Adhikari S. Transient neonatal hypocalcemia: presentation and outcomes. Pediatrics. 2012;129(6):e1461–7.

    Article  PubMed  Google Scholar 

  55. Greenberg MB, Penn AA, Whitaker KR, et al. Effect of magnesium sulfate exposure on term neonates. J Perinatol. 2013;33(3):188–93.

    Article  CAS  PubMed  Google Scholar 

  56. Mordes JP, Wacker WE. Excess magnesium. Pharmacol Rev. 1977;29(4):273.

    CAS  PubMed  Google Scholar 

  57. Blaine J, Chonchol M, Levi M. Renal control of calcium, phosphate, and magnesium homeostasis. Clin J Am Soc Nephrol. 2015;10(7):1257–72.

    Article  CAS  PubMed  Google Scholar 

  58. Bergwitz C, Jüppner H. Phosphate sensing. Adv Chronic Kidney Dis. 2011;18(2):132–44.

    Article  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy

    Alessandra Rizza & Zaccaria Ricci

Authors
  1. Alessandra Rizza
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  2. Zaccaria Ricci
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Editor information

Editors and Affiliations

  1. Pediatric and Adult Congenital Heart Disease Center, IRCCS Policlinico San Donato University Hospital, San Donato Milanese (MI), Italy

    Serena Francesca Flocco

  2. Policlinico S.Orsola-Malpighi, Bologna, Italy

    Angelo Lillo

  3. Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese (MI), Italy

    Federica Dellafiore

  4. Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven, Leuven, Belgium

    Eva Goossens

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Rizza, A., Ricci, Z. (2019). Fluid and Electrolyte Balance. In: Flocco, S., Lillo, A., Dellafiore, F., Goossens, E. (eds) Congenital Heart Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-78423-6_6

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  • DOI: https://doi.org/10.1007/978-3-319-78423-6_6

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