[Fluid and electrolyte balance in the postoperative period]

Authors investigated the concentration changes of arginine vasopressin (AVP) and of atrial natriuretic peptide (ANP) in plasma. The renal characteristics of water- and sodium metabolism in the first 24 hours of the postoperative period in 11 children operated with acute appendicitis have been studied. Crystalloid infusion was applied in 60 ml/kg/24 h dose, in 5 cases however, 1 g/kg albumin vas also administered during the operation. In children getting crystalloid infusion (group "A") the initial AVP value was 29.9 +/- 8.8 pg/ml, which further increased to 58.2 +/- 15.2 pg/ml (p 0.05) by the 6. postoperative hour and even in the 24. hour it remained above the physiological value (19.9 +/- 5.3 pg/ml). During the observation time significant Na- and water retention developed. The albumin administration (group "B") stopped the further increase of AVP values, the Na-household remained in equilibrium and the water retention developed only in smaller degree. The ANP plasma concentration of both groups was in the normal range and did not change during observation time. Our data show that for the postoperative water retention first of all the increased AVP activity is responsible. The more intensive AVP secretion may be induced by the relative intravascular hypovolemia since by enhancing the plasma volume the further increase of postoperative hormone activity could be prevented.