Effects Of Different Therapeutic Fluid Formulation On Continuous Renal Replacement Therapy On Serum Phosphorus In Pediatric

Objective:To observe the effect of different phosphorus concentration on serum phosphorus in critically ill children.Explore a reasonable,safe and effective approaches for phosphate repletion in critically ill children during CRRTMethods:Based on the real clinical events,a retrospective study was conducted on the children admitted to intensive care unit of Chongqing Medical University Affiliated Children’s Hospital from June 2019 to January 2017 and received continuous renal replacement treatment.According to the different methods of phosphorus supplementation,there were no phosphate preparations in the treatment solution(group A)、added 2 ml compound potassium hydrogen phosphate in treatment solution(B group,actual phosphorus concentration 1.5 mmol/L in treatment solution)、 added 3 ml compound potassium hydrogen phosphate in treatment solution(C group,actual phosphorus concentration 2 mmol/L in treatment solution).Compare the changes of serum phosphorus value before,during and after the first CRRT treatment in these three groups.Results: A total of 117 children were enrolled.Group A included 42 cases,group B included 23 cases and group C included 52 cases.There was no significant difference in sex,age,weight,critical illness score,CRRT duration,dialysis volume and replacement volume,ultrafiltration volume between the three groups(P>0.05).Serum phosphorus concentration of the three groups before treatment was compared,the difference was not statistically significant(P>0.05).The serum phosphorus values in the group A prior(1.16±0.57 mmol/L)and after treatment(0.95 and 0.58)were significantly lower than before treatment(1.79±1.05 mmol/L),the longer the time of CRRT,the more obvious the decrease was,and the difference was statistically significant(P<0.01).Serum phosphorus concentrations in group B were(1.76±1.17)、(1.68±0.97)、(1.61±1.01)mmol/L,the difference was not statistically significant(P>0.05).Serum phosphorus concentrations in group C were(1.85±1.08)、(1.81±0.89)、(1.80±1.02)mmol/L,the difference was not statistically significant(P>0.05).The incidence of hypophosphatemia in group A prior(73.8%)and after treatment(90.5%)was higher than before treatment(26.2%),With significant differences(P<0.01).The incidence of hypophosphatemia in group B were 30.4%、21.7%、17.4%,which had no significant difference(P>0.05).The incidence of hypophosphatemia in group C were34.6% 、 19.2% 、 17.4%,which had significant difference(P<0.05).The normal serum phosphorus rate of group A decreased gradually,and the normal serum phosphorus rate of group B and C increased gradually.The rate of hyperphosphatemia gradually decreased in groups of A 、 B and C.There was no significant difference in the rate of hyperphosphatemia in groups of A、B and C before treatment(P>0.05),and there was also no significant difference in treatment(P>0.05)and after treatment(P>0.05).Conclusion: Without phosphorus supplementation during CRRT treatment can lead to a decrease in phosphorus concentration and increase the risk of hypophosphatemia.Adding phosphate to the treatment solution can reduce the incidence of hypophosphatemia during and after CRRT treatment.The addition of 2 mmol/L of potassium hydrogen phosphate in the treatment solution was more beneficial to maintain the normal level of blood phosphorus during CRRT and after treatment than 1.5mmol/L.