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Acute Kidney Injury Secondary To Hyperchloremic Acidosis In Pediatric Patients Treated With Hypertonic Saline For Elevated Intracranial Pressure
Hellene Speicher, Mallary Biros
Rainbow Babies and Children's Hospital, Cleveland, OH

Background: Evaluate associations between acute kidney injury (AKI) and hypertonic saline (HTS) administration for increased intracranial pressures (ICP) in children following traumatic brain injury (TBI).
Methods: With IRB approval, we retrospectively reviewed medical charts of pediatric TBI patients admitted to our center between March 2015 and October 2019. Patients were identified using the ICD-9 and ICD-10 codes (S06.0 – S06.6) for TBI in a preexisting trauma registry. Inclusion criteria were age ≤ 18 years; admission to the Pediatric Intensive Care Unit, Emergency Department, or Operating Room; and administered HTS for suspected increased ICP as a result of a TBI. Exclusion criteria consisted of patients with pre-existing renal disease, grade III-V renal injury, no documented laboratory values within 6 hours of admission, or death within 16 hours of admission. Data collected included cumulative chloride dose, serum chloride, serum creatinine, pH, and eGFR every 6 hours from admission until hour 96 or death. AKI assessed using pediatric risk, injury, failure, loss, end stage renal disease criteria (pRIFLE). Data shown as n (%) or median (IQR).
Results: Among 39 patients, median age was 3 (1.5-8.5) years, median Glasgow Coma Score was 3 (3-7), and 22 (56.4%) patients were involved in a motor vehicle collision. Cumulative chloride dose was 483.8 (140.3-1406.5) mEq and four patients had eGFR decrease >25% (3 “risk”, 1 “failure”). Cumulative chloride dose poorly discriminated eGFR decrease >25% (AUC 0.59) and was not correlated with change in pH (Pearson coefficient = -0.07, p=0.701). Decrease in pH was associated with decreases in eGFR (Pearson coefficient = 0.55, p=0.001).
Conclusions: AKI was uncommon and not associated with total chloride administration in this cohort of pediatric TBI patients treated with HTS. Acidosis was associated with worsening renal function. Additionally research is needed to evaluate if HTS can predispose patients to AKI via hyperchloremic acidosis.


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