Rehydration using solutions with and without glucose before emergency abdominal surgery in children

Area of Science:

• Pediatric Surgery
• Clinical Nutrition
• Metabolic Research

Background:

• Preoperative rehydration is crucial for pediatric patients undergoing emergency abdominal surgery.
• Metabolic disturbances can occur during rehydration, impacting surgical outcomes.
• Evaluating different intravenous fluid solutions is essential for optimizing patient care.

Purpose of the Study:

• To compare the metabolic effects of six different intravenous rehydration solutions in children before emergency abdominal surgery.
• To identify the most appropriate rehydration solution for short-term correction of moderate dehydration in this patient population.

Main Methods:

• A prospective study involving 88 children undergoing emergency abdominal surgery.
• Administration of 5% body weight of six different intravenous solutions over 4 hours.
• Analysis of venous blood samples for glucose, insulin, alanine, 3-hydroxybutyrate (3-HB), non-esterified fatty acids (NEFA), glycerol, and base excess before and after rehydration.

Main Results:

• Glucose-free solutions (Ringer, Ringer lactate, Ringerdex) led to decreased glucose, insulin, NEFA, and 3-HB levels.
• Glucose-containing solutions (Rehydrex 2.5%, Rehydrex 5%, LGE) showed decreased NEFA and 3-HB levels.
• Rehydrex 5% caused hyperglycemia and hyperinsulinemia; LGE and Rehydrex 2.5% effectively reduced lipid mobilization and ketosis with minimal impact on glucose and insulin.

Conclusions:

• Low glucose electrolyte (LGE) solution and Rehydrex 2.5% are the most suitable for preoperative rehydration in pediatric emergency abdominal surgery.
• These solutions facilitate metabolic stability by reducing lipid mobilization and ketosis.
• Careful selection of rehydration solutions is vital to prevent adverse metabolic effects in pediatric surgical patients.