[Postoperative hyponatremia in children: pathophysiology, diagnosis and treatment].
OBJECTIVE
To review the current data on pathophysiology, causes and management of postoperative hyponatremia in children.


METHODS
The Pubmed database was searched for articles, combined with references analysis of major articles on the field.


RESULTS
The incidence of postoperative hyponatremia has been evaluated at 0.34% and its mortality significant. Postoperative hyponatremia is triggered by the diminished renal ability to excrete free water, due to antidiuretic hormone release. Inappropriate secretion of antidiuretic hormone is frequently seen after spine, cardiac and neurosurgery but can occur even after minor surgery. In this context, the infusion of hypotonic fluids represents a strong risk factor for developing hyponatremia. Other causes of hyponatremia are represented by extrarenal fluid losses, cerebral salt wasting syndrome, desalination phenomenon, adrenal insufficiency or some medications. Preventive treatment is essential and based on prohibition of hypotonic fluids infusion and the use of isotonic fluids infusions, maintenance of a normal total blood volume, the observance of the good practice recommendations for fluid infusion in children, and frequent blood and urine sodium concentration determinations in patients at risk for developing hyponatremia. Hyponatremic encephalopathy requires an emergent management, consisting in respiratory care and hypertonic sodium chloride infusion. Chronic hyponatremia is most often asymptomatic and the main neurological risk factor is represented by a too rapid correction of plasma sodium, which may lead to centropontine myelinolysis.
Brouh
Y
Y
Département d'anesthésie et de réanimation pédiatrique, faculté de médecine, université de la Méditerranée, CHU Timone-enfants, Marseille, France.
Paut
O
O
Tsimaratos
M
M
Camboulives
J
J
D002648:Child; D006801:Humans; D007010:Hyponatremia / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D007038:Hypotonic Solutions / Q000009:adverse effects; D007177:Inappropriate ADH Syndrome / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D012307:Risk Factors
D007038:Hypotonic Solutions