[Severe hyponatremic encephalopathy after pediatric surgery: report of seven cases and recommendations for management and prevention].
BACKGROUND
The infusion of hypotonic solutions in the perioperative period can lead to the development of hyponatraemic encephalopathy which is a severe, life threatening but preventable complication.


METHODS
Seven children aged 3-6 yr, ASA 1 or 2, operated on for a scheduled surgical procedure, presented at the 11th postoperative hour with seizures or status epilepticus, associated with vomiting (5/7), and a constant loss of consciousness (median Glasgow Coma Scale at 7), while one child presented with a respiratory arrest. At arrival in ICU, serum sodium was 120 mmol.L-1. All children had received in the perioperative period an hypotonic solution infusion (mainly dextrose 5%), at a high rate for most of them. Management included mechanical ventilation (3/7), antiepileptic drugs (7/7), fluid restriction (7/7), sodium chloride infusion (5/7), and diuretics (6/7). Serum sodium increased to a mean of 135 mmol.L-1 in 12 hours. Six children had a good neurologic outcome while one child died from brain death.


CONCLUSIONS
The use of hypotonic solute in the perioperative period can lead to hyponatremic encephalopathy, a severe neurologic complication of acute hyponatremia. It must be prevented by the use of appropriate solutions i-e isotonic fluids in regards of the low free water elimination capacities of the surgical patient.
Paut
O
O
Département d'anesthésie-réanimation pédiatrique, hôpital de La Timone-enfants, Marseille, France.
Rémond
C
C
Lagier
P
P
Fortier
G
G
Camboulives
J
J
D001927:Brain Diseases / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D003128:Coma / Q000209:etiology; D005260:Female; D006323:Heart Arrest / Q000209:etiology; D006801:Humans; D007010:Hyponatremia / Q000209:etiology*; D007038:Hypotonic Solutions; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D020250:Postoperative Nausea and Vomiting / Q000209:etiology; D012640:Seizures / Q000209:etiology
D007038:Hypotonic Solutions