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Impact of perioperative hyponatremia in children: A narrative review
Cheme Andersen1, Arash Afshari1
1Cheme Andersen, Arash Afshari, Department of Anaesthesiology, Juliane Marie Centre, Rigshospitalet, 2100 Copenhagen, Denmark.
Insights
Hypotonic fluids, standard for children, increase hyponatremia risk during surgery. This condition, characterized by low sodium levels, can cause serious neurological symptoms in pediatric patients.
Area of Science:
- Pediatric Anesthesiology
- Pediatric Nephrology
- Pediatric Critical Care
Background:
- Hypotonic fluids have been the standard for pediatric maintenance fluids for over 50 years.
- Recent studies and intense debate highlight the risks of hyponatremia associated with hypotonic versus isotonic fluids.
- Children undergoing surgery experience stimuli that increase antidiuretic hormone release, impairing free water excretion.
Purpose of the Study:
- To review the literature on perioperative hyponatremia in children.
- To describe the impact of hyponatremia in pediatric surgical patients.
- To raise awareness regarding the concern of widespread hypotonic fluid use in this population.
Main Methods:
- Literature review of studies evaluating hypotonic vs. isotonic fluids in children.
- Analysis of the physiological mechanisms leading to hyponatremia in surgical pediatric patients.
- Description of clinical manifestations and risks associated with hyponatremia.
Main Results:
- Hyponatremia, defined as plasma sodium < 136 mmol/L, can lead to cell swelling and central nervous system symptoms like seizures.
- The risk of symptomatic hyponatremia is higher in children than adults, representing an emergency condition.
- Increased antidiuretic hormone levels in surgical patients compromise the kidneys' ability to excrete free water.
Conclusions:
- The use of hypotonic fluids in pediatric surgical patients is a significant concern.
- Early diagnosis, prompt treatment, and close monitoring are crucial for reducing morbidity and mortality.
- Further focus and research are urgently needed to address the impact of perioperative hyponatremia in children.
Abstract:
For more than 50 years, hypotonic fluids (crystalloids) have been the standard for maintenance fluid used in children. In the last decade, several studies have evaluated the risk of hyponatremia associated with the use of hypotonic vs isotonic fluids, which has lead to an intense debate. Children undergoing surgery have several stimuli for release of antidiuretic hormone, which controls renal water handling, including pain, nausea, vomiting, narcotic use and blood loss. The body's primary defense against the development of hyponatremia is the ability of the kidneys to excrete free water and dilute urine. Increased levels of antidiuretic hormone can result in hyponatremia, defined as a plasma sodium level < 136 mmol/L, which causes cells to draw in excess water and swell. This manifests as central nervous system symptoms such as lethargy, irritability and seizures. The risk for symptomatic hyponatremia is higher in children than in adults. It represents an emergency condition, and early diagnosis, prompt treatment and close monitoring are essential to reduce morbidity and mortality. The widespread use of hypotonic fluids in children undergoing surgery is a matter of concern and more focus on this topic is urgently needed. In this paper, we review the literature and describe the impact of perioperative hyponatremia in children.
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