title: Randomized clinical trial of the effect of intravenous fluid administration on hormonal and renal dysfunction in patients with obstructive jaundice undergoing endoscopic drainage.
abstract: BACKGROUND
  Renal dysfunction in patients with biliary obstruction is associated with extracellular water depletion. This study examined the effect of preoperative saline infusion before biliary drainage on hormonal and renal functional derangements in patients with obstructive jaundice.
  
  
  METHODS
  In a randomized study, 49 patients with malignant obstructive jaundice were investigated at baseline, on the day of drainage, and at 24 h, 72 h and 7 days after internal endoscopic biliary drainage. Patients were randomized to receive (n = 22) or not to receive (n = 27) 3000 ml normal saline intravenously for 24 h before drainage. Variables analysed included extracellular water volume, creatinine clearance, and serum levels of aldosterone, renin, atrial natriuretic peptide (ANP), vasopressin and albumin.
  
  
  RESULTS
  Preoperative saline infusion produced a rise in creatinine clearance, diuresis, ANP concentration and extracellular water volume but this did not translate into better recovery of renal function after operation. Drainage produced a fall in creatinine clearance in all patients, but hormonal and renal function had recovered by 2 days after restoration of bile flow, independently of preoperative hydration.
  
  
  CONCLUSIONS
  Fluid administration expands the extracellular water compartment before drainage but fails to improve renal function after drainage. Definitive improvement in endocrine and renal function requires the restoration of bile flow into the duodenum.
authors.affiliation: Department of Surgery, Hospital Universitari del Mar, Barcelona, Spain.
authors.forename: F J
authors.initials: FJ
authors.lastname: Padillo
authors.forename: J
authors.initials: J
authors.lastname: Briceño
authors.forename: A
authors.initials: A
authors.lastname: Cruz
authors.forename: M
authors.initials: M
authors.lastname: Chicano
authors.forename: A
authors.initials: A
authors.lastname: Naranjo
authors.forename: J
authors.initials: J
authors.lastname: Vallejo
authors.forename: A
authors.initials: A
authors.lastname: Martín-Malo
authors.forename: C
authors.initials: C
authors.lastname: Pera-Madrazo
authors.forename: A
authors.initials: A
authors.lastname: Sitges-Serra
mesh_terms: D000328:Adult; D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood; D001661:Biliary Tract Neoplasms / Q000150:complications; D001663:Bilirubin / Q000097:blood; D003404:Creatinine / Q000378:metabolism; D004322:Drainage / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D041781:Jaundice, Obstructive / Q000209:etiology / Q000628:therapy*; D007674:Kidney Diseases / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012083:Renin / Q000097:blood; D012965:Sodium Chloride / Q000008:administration & dosage*
chemical_list: D012965:Sodium Chloride; D009320:Atrial Natriuretic Factor; D003404:Creatinine; D012083:Renin; D001663:Bilirubin