Top

Published in:

01-01-2016 | Educational Review

Perioperative fluid management and postoperative hyponatremia in children

Authors: Gia J. Oh, Scott M. Sutherland

Published in: Pediatric Nephrology | Issue 1/2016

Abstract

Intravenous (IV) fluids are used ubiquitously when children undergo surgical procedures. Until recently, Holliday and Segar’s guidelines for calculating maintenance fluids dictated fluid management strategies in postoperative pediatric patients. An increased recognition of hospital-acquired hyponatremia and its associated morbidity has led to a critical re-examination of IV fluid management in this population. Postsurgical patients are at high risk of developing hyponatremia due to the presence of non-osmotic stimuli for antidiuretic hormone release. Recent studies have established that, as they are administered in current practice, hypotonic maintenance fluids are associated with increased rates of hyponatremia. The best available data demonstrate that administration of isotonic fluid reduces hyponatremic risk. In this review, we discuss the collective data available on the subject and offer guidelines for fluid management and therapeutic monitoring.

Holliday MA, Segar WE (1957) The maintenance need for water in parenteral fluid therapy. Pediatrics 19:823–832PubMed

Moritz ML, Ayus JC (2003) Prevention of hospital-acquired hyponatremia: a case for using isotonic saline. Pediatrics 111:227–230CrossRefPubMed

Holliday MA, Friedman AL, Segar WE, Chesney R, Finberg L (2004) Acute hospital-induced hyponatremia in children: a physiologic approach. J Pediatr 145:584–587CrossRefPubMed

Arieff AI, Ayus JC, Fraser CL (1992) Hyponatraemia and death or permanent brain damage in healthy children. BMJ 304:1218–1222PubMedCentralCrossRefPubMed

Ayus JC, Arieff AI (1996) Brain damage and postoperative hyponatremia: the role of gender. Neurology 46:323–328CrossRefPubMed

Au AK, Ray PE, McBryde KD, Newman KD, Weinstein SL, Bell MJ (2008) Incidence of postoperative hyponatremia and complications in critically-ill children treated with hypotonic and normotonic solutions. J Pediatr 152:33–38CrossRefPubMed

Carandang F, Anglemyer A, Longhurst CA, Krishnan G, Alexander SR, Kahana M, Sutherland SM (2013) Association between maintenance fluid tonicity and hospital-acquired hyponatremia. J Pediatr 163:1646–1651CrossRefPubMed

Cladis FP, Bykowski M, Schmitt E, Naran S, Moritz ML, Cray J, Grunwaldt L, Losee J (2011) Postoperative hyponatremia following calvarial vault remodeling in craniosynostosis. Paediatr Anaesth 21:1020–1025CrossRefPubMed

Eulmesekian PG, Perez A, Minces PG, Bohn D (2010) Hospital-acquired hyponatremia in postoperative pediatric patients: prospective observational study. Pediatr Crit Care 11:479–483

10.

Chung HM, Kluge R, Schrier RW, Anderson RJ (1986) Postoperative hyponatremia. a prospective study. Arch Int Med 146:333–336CrossRef

11.

Wang J, Xu E, Xiao Y (2014) Isotonic versus hypotonic maintenance IV fluids in hospitalized children: a meta-analysis. Pediatrics 133:105–113CrossRefPubMed

12.

Yung M, Keeley S (2009) Randomised controlled trial of intravenous maintenance fluids. J Paediatr Child Health 45:9–14CrossRefPubMed

13.

Bailey AG, McNaull PP, Jooste E, Tuchman JB (2010) Perioperative crystalloid and colloid fluid management in children: where are we and how did we get here? Anesth Analg 110:375–390CrossRefPubMed

14.

Rowe JW, Shelton RL, Helderman JH, Vestal RE, Robertson GL (1979) Influence of the emetic reflex on vasopressin release in man. Kidney Int 16:729–735CrossRefPubMed

15.

Neville KA, Verge CF, O’Meara MW, Walker JL (2005) High antidiuretic hormone levels and hyponatremia in children with gastroenteritis. Pediatrics 116:1401–1407CrossRefPubMed

16.

Chiodera P, Volpi R, Capretti L, Speroni G, Marcato A, Rossi G, Coiro V (1992) Hypoglycemia-induced arginine vasopressin and oxytocin release is mediated by glucoreceptors located inside the blood–brain barrier. Neuroendocrinology 55:655–659CrossRefPubMed

17.

Hasegawa H, Okubo S, Ikezumi Y, Uchiyama K, Hirokawa T, Hirano H, Uchiyama M (2009) Hyponatremia due to an excess of arginine vasopressin is common in children with febrile disease. Pediatr Nephrol 24:507–511CrossRefPubMed

18.

Schrier RW, Berl T, Anderson RJ (1979) Osmotic and nonosmotic control of vasopressin release. Am J Physiol 236:F321–F332PubMed

19.

Philbin DM, Coggins CH (1980) The effects of anesthesia on antidiuretic hormone. Contemp Anesth Pract 3:29–38PubMed

20.

Levine FH, Philbin DM, Kono K, Coggins CH, Emerson CW, Austen WG, Buckley MJ (1981) Plasma vasopressin levels and urinary sodium excretion during cardiopulmonary bypass with and without pulsatile flow. Ann Thorac Surg 32:63–67CrossRefPubMed

21.

Burrows FA, Shutack JG, Crone RK (1983) Inappropriate secretion of antidiuretic hormone in a postsurgical pediatric population. Crit Care Med 11:527–531CrossRefPubMed

22.

Brazel PW, McPhee IB (1996) Inappropriate secretion of antidiuretic hormone in postoperative scoliosis patients: the role of fluid management. Spine 21:724–727CrossRefPubMed

23.

Choong K, Arora S, Cheng J, Farrokhyar F, Reddy D, Thabane L, Walton JM (2011) Hypotonic versus isotonic maintenance fluids after surgery for children: a randomized controlled trial. Pediatrics 128:857–866CrossRefPubMed

24.

Kanda K, Nozu K, Kaito H, Iijima K, Nakanishi K, Yoshikawa N, Ninchoji T, Hashimura Y, Matsuo M, Moritz ML (2011) The relationship between arginine vasopressin levels and hyponatremia following a percutaneous renal biopsy in children receiving hypotonic or isotonic intravenous fluids. Pediatr Nephrol 26:99–104CrossRefPubMed

25.

Kliegman R, Nelson WE (2011) Nelson textbook of pediatrics. Elsevier/Saunders, Philadelphia

26.

Moritz ML, Ayus JC (2010) Water water everywhere: standardizing postoperative fluid therapy with 0.9% normal saline. Anesth Analg 110:293–295CrossRefPubMed

27.

Rey C, Los-Arcos M, Hernandez A, Sanchez A, Diaz JJ, Lopez-Herce J (2011) Hypotonic versus isotonic maintenance fluids in critically ill children: a multicenter prospective randomized study. Acta Paediatr 100:1138–1143CrossRefPubMed

28.

Neville KA, Sandeman DJ, Rubinstein A, Henry GM, McGlynn M, Walker JL (2010) Prevention of hyponatremia during maintenance intravenous fluid administration: a prospective randomized study of fluid type versus fluid rate. J Pediatr 156(313–319):e311–e312

29.

Coulthard MG, Long DA, Ullman AJ, Ware RS (2012) A randomised controlled trial of Hartmann’s solution versus half normal saline in postoperative paediatric spinal instrumentation and craniotomy patients. Arch Dis Child 97:491–496CrossRefPubMed

30.

McNab S, Duke T, South M, Babl FE, Lee KJ, Arnup SJ, Young S, Turner H, Davidson A (2014) 140 mmol/L of sodium versus 77 mmol/L of sodium in maintenance intravenous fluid therapy for children in hospital (PIMS): a randomised controlled double-blind trial. Lancet. doi:10.1016/S0140-6736(14)61459-8 PubMed

31.

Saba TG, Fairbairn J, Houghton F, Laforte D, Foster BJ (2011) A randomized controlled trial of isotonic versus hypotonic maintenance intravenous fluids in hospitalized children. BMC Pediatr 11:82PubMedCentralCrossRefPubMed

32.

Hanna M, Saberi MS (2010) Incidence of hyponatremia in children with gastroenteritis treated with hypotonic intravenous fluids. Pediatr Nephrol 25:1471–1475CrossRefPubMed

33.

Ellison DH, Berl T (2007) Clinical practice. the syndrome of inappropriate antidiuresis. New Engl J Med 356:2064–2072CrossRefPubMed

34.

Myburgh JA, Mythen MG (2013) Resuscitation fluids. New Eng J Med 369:2462–2463CrossRefPubMed

35.

Roth JV (2011) Pediatric postoperative fluid therapy: avoiding hyponatremia. Anesth Analg 112:246, author reply 247CrossRefPubMed

36.

Houghton J, Wilton N (2011) Choice of isotonic perioperative fluid in children. Anesth Analg 112:246–247, author reply 247CrossRefPubMed

37.

Shaw AD, Bagshaw SM, Goldstein SL, Scherer LA, Duan M, Schermer CR, Kellum JA (2012) Major complications, mortality, and resource utilization after open abdominal surgery: 0.9% saline compared to Plasma-Lyte. Ann Surg 255:821–829CrossRefPubMed

38.

Hoorn EJ, Geary D, Robb M, Halperin ML, Bohn D (2004) Acute hyponatremia related to intravenous fluid administration in hospitalized children: an observational study. Pediatrics 113:1279–1284CrossRefPubMed

39.

Hatherill M, Waggie Z, Salie S, Argent A (2004) Hospital-acquired hyponatremia is associated with excessive administration of intravenous maintenance fluid. Pediatrics 114:1368, author reply 1368–1369CrossRefPubMed

40.

Taylor D, Durward A (2004) Pouring salt on troubled waters. Arch Dis Child 89:411–414PubMedCentralCrossRefPubMed

41.

Yunos NM, Bellomo R, Hegarty C, Story D, Ho L, Bailey M (2012) Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA 308:1566–1572CrossRefPubMed

42.

Holliday MA, Ray PE, Friedman AL (2007) Fluid therapy for children: facts, fashions and questions. Arch Dis Child 92:546–550PubMedCentralCrossRefPubMed

43.

Snaith R, Peutrell J, Ellis D (2008) An audit of intravenous fluid prescribing and plasma electrolyte monitoring; a comparison with guidelines from the National Patient Safety Agency. Paediatr Anaesth 18:940–946CrossRefPubMed

Title: Perioperative fluid management and postoperative hyponatremia in children
Authors: Gia J. Oh
Scott M. Sutherland
Publication date: 01-01-2016
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Nephrology / Issue 1/2016
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-015-3081-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Perioperative fluid management and postoperative hyponatremia in children

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2016

Drugs as risk factors of acute kidney injury in critically ill children

Risk factors for relapse and long-term outcome in steroid-dependent nephrotic syndrome treated with rituximab

Peritoneal–pericardial communication in an adolescent on peritoneal dialysis

Prevalence and correlates of 25-hydroxyvitamin D deficiency in the Chronic Kidney Disease in Children (CKiD) cohort

Dealing with the incidental finding of secondary variants by the example of SRNS patients undergoing targeted next-generation sequencing

Plasma levels of oxidative stress in children with steroid-sensitive nephrotic syndrome and their predictive value for relapse frequency