Introduction:

hyperchloremia and hypernatremia are common complications in critically ill children and have been associated with the development of acute kidney injury (AKI) and mortality.

Objective:

to estimate the incidence of hyperchloremia and hypernatremia during the first 72 hours of admission to a pediatric intensive care unit (PICU), and to evaluate their association with AKI and mortality.

Material and methods:

prospective cohort study, conducted over a period of 15 months. Patients with disorders in plasma levels of chloride (Cl-) or sodium (Na+), as well as with AKI at the time of admission, were excluded. Values > 110 mEq/L Cl- and > 145 mEq/L Na+ were considered as hyperchloremia and hypernatremia, respectively. A sample size of 255 patients was calculated. Statistical analysis. Odds Ratio (OR) and 95% confidence intervals (95% CI) were calculated for bivariate and multivariate analyses.

Results:

among 241 patients, the incidence of hyperchloremia was 12.4% (n = 30), and of hypernatremia 18.6% (n = 45). The frequency of AKI was 35.6%, and mortality was 14.1%. In logistic regression analysis, hypernatremia was associated with AKI (OR 2.7, 95% CI 1.3-5.7, p < 0.006), but not with mortality. While hyperchloremia was not identified as a risk for AKI or death.

Conclusions:

hyperchloremia and hypernatremia are common in critically ill pediatric patients, but only hypernatremia seems to confer a higher risk of complications.