Prevention of Hyponatremia during Maintenance Intravenous Fluid Administration: A Prospective Randomized Study of Fluid Type versus Fluid Rate - 07/03/14
Abstract |
Objectives |
To determine the importance of sodium content versus administration rate of intravenous fluids in the development of hyponatremia in postoperative children.
Study design |
In this prospective, randomized, nonblinded study, 124 children admitted for surgery received 0.9% (NS) or 0.45% (N/2) saline solution at 100% or 50% maintenance rates. Plasma electrolytes, osmolality, and ADH at induction of anesthesia were compared with values 8 hours (T8), and 24 hours (T24; n = 67) after surgery. Blood glucose and ketones were measured every 4 hours. Electrolytes and osmolality were measured in urine samples.
Results |
Plasma sodium concentrations fell in both N/2 groups at T8 (100%: −1.5 ± 2.3mmol/L 50%: −1.9 ± 2.0mmol/L; P < .01) with hyponatremia more common than in the NS groups at T8 (30% vs 10%; P = .02) but not T24. Median plasma antidiuretic hormone concentrations increased 2- to 4-fold during surgery (P ≤ .001) and only reattained levels at induction of anesthesia by T24 in the N/2 100% group. On multiple linear regression analysis, fluid type, not rate determined risk of hyponatremia (P < .04). Two children on 100% developed SIADH (1NS). Fourteen (23%; 7NS) on 50% maintenance were assessed as dehydrated. Dextrose content was increased in 18 for hypoglycemia or ketosis.
Conclusions |
The risk of hyponatremia was decreased by isotonic saline solution but not fluid restriction.
Le texte complet de cet article est disponible en PDF.Mots-clés : 2.5%D, 5%D, ADH, BG, NS, N/2, SIADH, T8, T24, Text, Tind
Plan
| Supported by Sydney Children’s Hospital Foundation. The authors declare no conflicts of interest. |
Vol 156 - N° 2
P. 313 - février 2010 Retour au numéro
Article précédent
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