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Hypotonic versus isotonic maintenance fluids after surgery for children: a randomized controlled trial
Karen Choong1, Steve Arora, Ji Cheng
1Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. choongk@mcmaster.ca
Pediatrics
|October 19, 2011
Summary
Isotonic parenteral maintenance solutions (PMS) are safer than hypotonic PMS for children after surgery. Isotonic solutions significantly reduce the risk of hyponatremia, a dangerous drop in sodium levels.
Area of Science:
- Pediatric critical care
- Clinical trials
- Fluid management
Background:
- Postoperative hyponatremia is a significant concern in pediatric patients.
- Parenteral maintenance solutions (PMS) are commonly used for fluid management in these patients.
- The choice between isotonic and hypotonic solutions may impact electrolyte balance.
Purpose of the Study:
- To compare the risk of hyponatremia in pediatric surgical patients receiving isotonic (0.9% saline) versus hypotonic (0.45% saline) PMS.
- To evaluate secondary outcomes including severe hyponatremia, hypernatremia, and adverse events.
Main Methods:
- A randomized controlled trial involving 258 pediatric surgical patients (6 months to 16 years).
- Patients received either isotonic or hypotonic PMS for 48 hours.
- Primary outcome was acute hyponatremia; secondary outcomes included severe hyponatremia and hypernatremia.
Main Results:
- Hypotonic PMS significantly increased the risk of hyponatremia compared to isotonic PMS (40.8% vs 22.7%).
- Isotonic PMS did not increase the risk of hypernatremia.
- No significant differences in antidiuretic hormone levels or adverse events were observed between groups.
Conclusions:
- Isotonic PMS is significantly safer than hypotonic PMS for preventing acute postoperative hyponatremia in children.
- This finding supports the use of isotonic solutions for maintenance fluid therapy in pediatric surgical patients.
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