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

The metabolic effects of six different solutions used for rehydration were studied in 88 children before emergency abdominal surgery. A volume corresponding to 5% of the body weight was given i.v. during 4 h (12.5 ml . kg-1 . h-1) between admission and surgery. The different solutions were: low glucose electrolyte solution (LGE), Rehydrex 2.5%, Rehydrex 5% containing 0.9, 2.5 and 5.0% glucose, respectively, Ringer, Ringer lactate and Ringerdex (30 mmol acetate . l-1). Venous blood samples were drawn before and after rehydration and analysed for glucose, insulin, alanine, 3-hydroxybutyrate (3-HB), non-esterified fatty acids (NEFA), glycerol and base excess. Before rehydration the plasma concentrations of NEFA, glycerol and 3-HB were elevated, while that of alanine was decreased. Plasma levels of NEFA and 3-HB remained unchanged, whereas glucose and insulin decreased after rehydration with glucose-free solutions, i.e. Ringer, Ringer lactate and Ringerdex. With solutions containing glucose the concentrations of NEFA and 3-HB decreased significantly. With Rehydrex 5% hyperglycaemia and hyperinsulinaemia were observed. Rehydration using LGE and especially Rehydrex 2.5% resulted in decreased lipid mobilization and ketonaemia without concomitant marked increase of glucose and insulin. LGE and Rehydrex 2.5% thus appeared to be the most appropriate solutions in a situation where moderate dehydration had to be corrected during a short period of time before emergency abdominal surgery.