EVIDENCED-BASED NURSING

I. Clinical Question

Gastroenteritis: Is Plasma-Lyte A (PLA) more effective as alternative fluid maintenance than 0.9 %
sodium chloride (NaCl) intravenous (IV) fluid?

Patient Focus Population Intervention Comparison Outcome

100 patients ≥6
months to <11 years
of age were with
moderate-to-
severe dehydration
due to AGE, defined
as ≥3 episodes of
diarrhea or
nonbilious
vomiting
0.9 % sodium chloride
(NaCl) intravenous (IV)
fluid
Plasma-Lyte A (PLA) In comparison with 0.9 %
NaCl, PLA for rehydration
in children with AGE was
well tolerated and led to
more rapid improvement in
serum bicarbonate and
dehydration score.

II. Citation: Title of the Journal article on a research related to your case

MAIN JOURNAL: Allen, C. H., Goldman, R. D., Bhatt, S., Simon, H. K., Gorelick, M. H., Spandorfer, P.
R., … Goldstein, S. L. (2016). A randomized trial of Plasma-Lyte A and 0.9 % sodium chloride in acute
pediatric gastroenteritis. BMC Pediatrics, 16(1). https://doi.org/10.1186/s12887-016-0652-4

SUPPORTING JOURNAL: Edwards ED, Mason BW. Plasma-lyte for intravenous fluid maintenance,
replacement or resuscitation as an alternative to other intravenous fluids in paediatric patients: A systematic
review. J Pedia Health Care Med 2018;1(1):23-26.

III. Study Characteristics:

Patients included in the study were ≥6 months to <11 years of age were
eligible for enrollment if they presented to the ED with moderate to-severe
dehydration due to AGE, defined as ≥3 episodes of diarrhea or nonbilious
vomiting within the previous 24 h and a Gorelick dehydration score ≥4.
Exclusion criteria on participants included were AGE that did not require
IVT per clinicians’ judgment, chronic health conditions such as renal failure
affecting the ability to tolerate fluids or those that result in electrolyte
abnormalities, or the use of prohibited medications such as antacids/anti-
diarrhea or systemic corticosteroids within 24 or 72 h prior to presentation,
respectively. Interventions compared on the study were the comparison with
0.9 % NaCl and PLA for rehydration in children with AGE. Outcome monitored
on the study was the measurement of serum bicarbonate level, safety of the
intervention as well as its tolerability. Further, The aim of this study is to
 assess evidence which compares the outcome in paediatric patients of using
PLA for intravenous fluid maintenance, replacement or resuscitation as an
alternative to other intravenous fluids. Herewith, the study focuses on the
significant problem in clinical practice since Acute gastroenteritis (AGE)
complicated by dehydration remains a major cause of childhood morbidity
and mortality, requiring significant healthcare expenditure worldwide.
On the other hand, the study of Edwards et. al (2018), it only focuses on studies and literature in
pediatric clients. Outcome monitored were the assessment and evaluation of Plasma-Lyte for intravenous
fluid maintenance, replacement or resuscitation as an alternative to other intravenous fluids. Just like the
fist journal, it aims to aid dehydration and to have a significance on health promotion.

IV. Methodology/Design
The study was a prospective, randomized, triple-blind, company sponsored, active-controlled
study that was conducted at 8 pediatric emergency departments (ED) in the US and Canada. Institutional
ethics approval was obtained from each institution and written informed consent was obtained from the
parent/legal guardian of all children before randomization. Safety data were periodically monitored by an
independent consultant (pediatric nephrologist, SLG) who was not involved in patient recruitment or
management (Allen et al, 2016). Data sources came from the primary sources such as records and reports of
the studies gathered during the study. The supporting journal was a systematic review of published, original
research articles of any design regarding the topic plasma-lyte for intravenous fluid maintenance,
replacement or resuscitation. The study was replicated; indeed, it is another clinical surveillance of the
comparative pharmacological intervention in line with gastroenteritis. Existing studies similar to this study
we found online also tackles PLA as an alternative fluid maintenance.The risks found in the study was the
population group because they are young and it is still a clinical trial that might trigger underlying
conditions. However, the study promoted safety measures such as safety assessments— including physical
examinations, laboratory assessments, and any reported or observed adverse events. Safety follow-ups,
information was obtained regarding AEs, unplanned return visits, and hospital admission were strictly
implemented. Institutional ethics approval was obtained from each institution and written informed consent
was obtained from the parent/legal guardian of all children before randomization.

V. Results of the Study

The results have shown in the study (Allen et al, 2016) that at the baseline, the treatment groups
were comparable except that the PLA group was older than the other. At hour 4, the PLA group had greater
increases in serum bicarbonate from baseline than did the 0.9 % NaCl group; change from baseline of 1.6
and 0.0, respectively. Both treatment groups received similar fluid volumes. The PLA group had less
abdominal pain and better dehydration scores at hour )but not at hour 4. No patient experienced clinically
relevant worsening of laboratory findings or physical examination, and hospital admission rates were
similar. One patient in each treatment group developed hyponatremia. Four patients developed
hyperkalemia (PLA:1, 0.9 % NaCl:3).
On the top of that, the supporting journal results articulated that plasma-Lyte is a licensed isotonic
fluid that can be used for intravenous fluid maintenance, replacement and resuscitation in children and
infants.
VI. Applicability

The research study was able to prove a response to the clinical question mentioned above in terms
of patients, interventions and process.The study yielded positive results on both intervention and proven
another intervention to be effective and efficient in respect with the conditions of pediatric clients. Also, the
study can be a good source of evidence-based nursing practice knowledge especially on the dependent
actions we perform when promoting health restoration. The study’s interventions were feasible enough to
be carried out to the hospital settings; however, low income countries might have difficulties in
implementing such trials especially in the public hospital settings—due to lack of budget or allocation of
funds.

VII. Reviewer’s Conclusion/Commentary

All of the journals mentioned were a good reference because they were supported with previous
studies and literature; hence, making it more reliable and carried with facts.On the two interventions, both
were effective; nevertheless, PLA was proven appropriate alternative to 0.9 % NaCl because it provides
the necessary water and electrolyte replacement, and as an alkalinizing agent it may ameliorate the clinical
sequelae of AGE-induced acidosis. However, the intervention is affecting the opportunities of low income
countries for the health restoration process as the intervention might be costly. Nonetheless, both
interventions were significantly useful in the field of research and nursing practices and management.
These two studies are another sources for recommendation as it is clinically proven to improve the health
care services implemented that will eventually save lives in the future.