ESPN 50th Annual Meeting

ESPN 2017


 
Optimising fluid intake helps in the management of vomiting in infants and children with chronic kidney disease: a case series
Triona Joyce 1 Frances Court Brown 1 Pernille Rasmussen 1 Simon Waller 1 Jo Clothier 1 Caroline Booth 1

1- Evelina London Childrens Hospital, London, UK
 
Introduction:

It is well recognised that vomiting frequently occurs in infants and children with chronic kidney disease (CKD). Multiple factors have been proposed to explain its’ occurrence including gastroesophageal reflux and delayed gastric emptying.

Material and methods:

We retrospectively report 3 patients with CKD who were receiving enteral feeds and experienced issues with vomiting.

Results:

Patient 1: 28 month old girl with CKD following placental abruption. Vomiting daily for the previous 5 months despite domperidone. Care transferred to our unit with plan for fundoplication. On presentation 110mls/kg/d total water from gastrostomy feeds and oral water. Initially feeds changed to ¼ strength and total water (all sources) increased to 145mls/kg/d. Vomiting settled and feeds increase to full strength over 2 week period. Patient 2: 3 day old boy with PUV and left multicystic dysplastic kidneys. Feeds provided 180mls/kg/d water and family advised to offer water between feeds. Two weeks later started vomiting, had outgrown 180mls/kg/d target and parents admitted difficulty giving additional water. Additional water added to feeds to achieve 180mls/kg/d and vomiting settled. No anti-reflux medications required. Patient 3: 1 month old girl with dysplastic kidneys tolerated continuous feeds (155mls/kg/d fluid) but would vomit when bolus feeds were trialled. Half strength continuous feeds with increasing water to 170mls/kg/d were not tolerated. Patient given IV fluids and domperidone over a weekend period then successfully regraded to continuous feeds of 170mls/kg/d.

Conclusions:

Optimising fluid intake as water either added to feeds and/or given separately helps in the management of vomiting in infants and children with CKD. Further work is required to investigate this relationship.