Prevention of hyponatremia during maintenance intravenous fluid administration: a prospective randomized study of
Kristen A Neville1, David J Sandeman, Alan Rubinstein
1Department of Endocrinology, Sydney Children's Hospital, Randwick, Australia; School of Women's & Children's Health, University of New South Wales, Sydney, Australia.
Insights
Isotonic saline solution, not fluid restriction, reduces hyponatremia risk in children post-surgery. Lower sodium fluids increased hyponatremia incidence and dehydration risk.
Area of Science:
- Pediatric Anesthesiology and Critical Care
- Intravenous Fluid Therapy Management
- Electrolyte Balance and Hyponatremia Research
Background:
- Postoperative hyponatremia is a significant concern in pediatric patients.
- The roles of sodium content and fluid administration rate in hyponatremia development are not fully elucidated.
- Understanding these factors is crucial for optimizing perioperative fluid management.
Purpose of the Study:
- To compare the impact of sodium concentration versus fluid administration rate on hyponatremia development in postoperative children.
- To investigate the relationship between intravenous fluid composition and postoperative electrolyte disturbances.
- To identify key determinants of hyponatremia risk in surgical pediatric patients.
Main Methods:
- Prospective, randomized, nonblinded study involving 124 pediatric surgical patients.
- Patients received either 0.9% (NS) or 0.45% (N/2) saline at 100% or 50% maintenance rates.
- Plasma electrolytes, osmolality, and antidiuretic hormone (ADH) levels were monitored at baseline, 8 hours (T8), and 24 hours (T24) post-surgery.
Main Results:
- Hyponatremia was more common in the N/2 groups at T8 (30% vs. 10% in NS groups, P = .02).
- Fluid type, specifically lower sodium concentration (N/2), was identified as the primary risk factor for hyponatremia (P < .04).
- ADH levels increased significantly during surgery, with delayed normalization in the N/2 100% group; 23% on 50% maintenance were assessed as dehydrated.
Conclusions:
- The use of isotonic saline solution (0.9% NS) effectively decreased the risk of hyponatremia.
- Fluid restriction (50% maintenance rate) did not prevent hyponatremia and was associated with dehydration.
- Sodium content of intravenous fluids is a more critical factor than administration rate in preventing postoperative hyponatremia in children.
Objectives:
To determine the importance of sodium content versus administration rate of intravenous fluids in the development of hyponatremia in postoperative children.
Study Design:
In this prospective, randomized, nonblinded study, 124 children admitted for surgery received 0.9% (NS) or 0.45% (N/2) saline solution at 100% or 50% maintenance rates. Plasma electrolytes, osmolality, and ADH at induction of anesthesia were compared with values 8 hours (T(8)), and 24 hours (T(24); n = 67) after surgery. Blood glucose and ketones were measured every 4 hours. Electrolytes and osmolality were measured in urine samples.
Results:
Plasma sodium concentrations fell in both N/2 groups at T(8) (100%: -1.5 +/- 2.3 mmol/L 50%: -1.9 +/- 2.0 mmol/L; P < .01) with hyponatremia more common than in the NS groups at T(8) (30% vs 10%; P = .02) but not T(24). Median plasma antidiuretic hormone concentrations increased 2- to 4-fold during surgery (P < or = .001) and only reattained levels at induction of anesthesia by T(24) in the N/2 100% group. On multiple linear regression analysis, fluid type, not rate determined risk of hyponatremia (P < .04). Two children on 100% developed SIADH (1NS). Fourteen (23%; 7NS) on 50% maintenance were assessed as dehydrated. Dextrose content was increased in 18 for hypoglycemia or ketosis.
Conclusions:
The risk of hyponatremia was decreased by isotonic saline solution but not fluid restriction.
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