title: A randomised controlled trial of Hartmann's solution versus half normal saline in postoperative paediatric spinal instrumentation and craniotomy patients.
abstract: OBJECTIVE
  To compare the difference in plasma sodium at 16-18 h following major surgery in children who were prescribed either Hartmann's and 5% dextrose or 0.45% saline and 5% dextrose.
  
  
  METHODS
  A prospective, randomised, open label study.
  
  
  METHODS
  The paediatric intensive care unit (650 admissions per annum) in a tertiary children's hospital in Brisbane, Australia.
  
  
  METHODS
  The study group comprised 82 children undergoing spinal instrumentation, craniotomy for brain tumour resection, or cranial vault remodelling.
  
  
  METHODS
  Patients received either Hartmann's and 5% dextrose at full maintenance rate or 0.45% saline and 5% dextrose at two-thirds maintenance rate.
  
  
  METHODS
  
  
  
  METHODS
  plasma sodium at 16-18 h postoperatively; secondary outcome measure: number of fluid boluses administered.
  
  
  RESULTS
  Mean postoperative plasma sodium levels of children receiving 0.45% saline and 5% dextrose were 1.4 mmol/l (95% CI 0.4 to 2.5) lower than those receiving Hartmann's and 5% dextrose (p=0.008). In the 0.45% saline group, seven patients (18%) became hyponatraemic (Na <135 mmol/l) at 16-18 h postoperatively; in the Hartmann's group no patient became hyponatraemic (p=0.01). No child in either fluid group became hypernatraemic.
  
  
  CONCLUSIONS
  The postoperative fall in plasma sodium was smaller in children who received Hartmann's and 5% dextrose compared to those who received 0.45% saline and 5% dextrose. It is suggested that Hartmann's and 5% dextrose should be administered at full maintenance rate postoperatively to children who have undergone major surgery in preference to hypotonic fluids.
authors.affiliation: Academic Discipline of Paediatrics and Child Health, University of Queensland, Herston, QLD 4029, Australia. Mark_Coulthard@health.qld.gov.au
authors.forename: Mark G
authors.initials: MG
authors.lastname: Coulthard
authors.forename: Debbie A
authors.initials: DA
authors.lastname: Long
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Ullman
authors.forename: Robert S
authors.initials: RS
authors.lastname: Ware
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D005947:Glucose / Q000627:therapeutic use; D006801:Humans; D015278:Intensive Care Units, Pediatric; D007552:Isotonic Solutions / Q000627:therapeutic use*; D008297:Male; D011184:Postoperative Period; D011446:Prospective Studies; D000077325:Ringer's Lactate; D012964:Sodium / Q000097:blood*; D012965:Sodium Chloride / Q000627:therapeutic use*; D013131:Spine / Q000601:surgery
chemical_list: D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D012965:Sodium Chloride; D012964:Sodium; D005947:Glucose