IngentaConnect Body water and plasma volume in severe community-acquired pneumon...

Abstract:

Objectives: To determine changes in total and extracellular body water, plasma volume and sodium in children with severe and very severe pneumonia, and examine the association between these changes and oxygenation.

Design: Prospective, observational.

Subjects: Fifty children aged 2–59 mths with severe and very severe pneumonia.

Methods: Serum sodium (SNa), plasma osmolality (Posm), urinary sodium (UNa) and osmolality, total body water (TBW), extracellular water (ECW) and plasma volume (PV) were estimated during the acute phase of pneumonia (within 3–6 hrs of presentation) and after recovery. These were correlated with oxygen saturation (SpO₂) recorded on presentation.

Results: All children had cough, fever, tachypnoea and chest-wall indrawing; 70% had inability to feed and 90% were hypoxaemic (SpO₂ ≤ 90%). During the acute phase of illness, among the survivors (n=46), mean (SD) ECW and PV were significantly higher than that after recovery [ECW 318 (45) vs 308 (49) ml/kg, PV 53.2 (2.3) vs 52.1 (2.3) ml/kg, p<0.05]. SNa ≤ 135 mmmol/L was significantly correlated with ECW and PV excess. SpO₂ showed a significant linear relationship with TBW, ECW and PV (r=0.43, 0.46 and 0.42, respectively, p<0.005) and SNa (r=<0.33, p=0.02). On multiple regression analysis, ECW, blood urea and PV were significant predictors of SpO₂ (combined r=0.63). The four patients who died had significantly higher Posm and blood urea and lower SpO₂ but in a logistic regression model SpO₂ was the only significant predictor of death (odds ratio 0.54, 95% CI 0.32–0.9, p=0.02).

Conclusion: ECW and PV were moderately increased in severe and very severe pneumonia and the increase correlated with better oxygenation. These findings suggest that fluid retention in response to hypoxaemia is directed towards improving circulating volume. The current practice of fluid restriction in hypoxaemic patients with severe pneumonia might be logical only after correction of hypoxaemia.

Document Type: Research article

DOI: 10.1179/146532805X72386

Affiliations: 1: Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India 2: Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

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Body water and plasma volume in severe community-acquired pneumonia: implications for fluid therapy