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Comparison of two maintenance electrolyte solutions in children in the postoperative appendectomy period: a
Maria Clara da Silva Valadão1, Jefferson Pedro Piva2, João Carlos Batista Santana3
1Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil; Hospital Universitário de Santa Maria (HUSM), Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brazil.
Insights
In pediatric appendectomy patients, hypotonic (0.18%) or isotonic (0.9%) saline solutions did not significantly alter postoperative hyponatremia risk. Hypotonic solutions led to greater preoperative fluid balance in children.
Area of Science:
- Pediatric Surgery
- Intravenous Fluid Therapy
- Electrolyte Balance
Background:
- Postoperative hyponatremia is a concern in pediatric surgery.
- Appropriate intravenous fluid selection is crucial for managing electrolyte balance in children.
Purpose of the Study:
- To compare the incidence of hyponatremia and water retention between isotonic and hypotonic maintenance solutions post-appendectomy in children.
- To evaluate the safety and efficacy of different electrolyte solutions in pediatric surgical patients.
Main Methods:
- A randomized clinical study involving 50 pediatric patients undergoing appendectomy.
- Patients received either isotonic (0.9% NaCl) or hypotonic (0.18% NaCl) solutions at 2,000mL/m(2)/day.
- Electrolytes, glucose, urea, creatinine, fluid balance, and weight were monitored preoperatively and up to 48 hours postoperatively.
Main Results:
- No significant difference in hyponatremia incidence or resolution between isotonic and hypotonic groups at 48 hours post-surgery.
- Both groups showed similar increases in sodium levels at 24 and 48 hours, with no significant intergroup differences.
- Patients receiving hypotonic solutions exhibited a higher cumulative fluid balance in the preoperative period.
Conclusions:
- The use of hypotonic (0.18%) maintenance solution did not increase the risk of hyponatremia compared to isotonic (0.9%) saline in the post-appendectomy period.
- Isotonic saline did not lead to hypernatremia in these pediatric patients.
- Hypotonic fluid administration in the preoperative period was associated with increased fluid retention.
Objective:
To compare two electrolyte maintenance solutions in the postoperative period in children undergoing appendectomy, in relation to the occurrence of hyponatremia and water retention.
Methods:
A randomized clinical study involving 50 pediatric patients undergoing appendectomy, who were randomized to receive 2,000mL/m(2)/day of isotonic (Na 150 mEq/L or 0.9% NaCl) or hypotonic (Na 30 mEq/L NaCl or 0.18%) solution. Electrolytes, glucose, urea, and creatinine were measured at baseline, 24h, and 48h after surgery. Volume infused, diuresis, weight, and water balance were analyzed.
Results:
Twenty-four patients had initial hyponatremia; in this group, 13 received hypotonic solution. Seventeen patients remained hyponatremic 48h after surgery, of whom ten had received hypotonic solution. In both groups, sodium levels increased at 24h (137.4±2.2 and 137.0±2.7mmol/L), with no significant difference between them (p=0.593). Sodium levels 48h after surgery were 136.6±2.7 and 136.2±2.3mmol/L in isotonic and hypotonic groups, respectively, with no significant difference. The infused volume and urine output did not differ between groups during the study. The water balance was higher in the period before surgery in patients who received hypotonic solution (p=0.021).
Conclusions:
In the post-appendectomy period, the use of hypotonic solution (30 mEq/L, 0.18%) did not increase the risk of hyponatremia when compared to isotonic saline. The use of isotonic solution (150 mEq/L, 0.9%) did not favor hypernatremia in these patients. Children who received hypotonic solution showed higher cumulative fluid balance in the preoperative period.
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