title: Perioperative fluid management and postoperative hyponatremia in children.
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.
authors.affiliation: Department of Pediatrics, Division of Nephrology, Stanford University, 300 Pasteur Drive, Room G306, Stanford, CA, 94305, USA. gjoh@stanford.edu.
authors.forename: Gia J
authors.initials: GJ
authors.lastname: Oh
authors.affiliation: Department of Pediatrics, Division of Nephrology, Stanford University, 300 Pasteur Drive, Room G306, Stanford, CA, 94305, USA.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Sutherland
mesh_terms: D000367:Age Factors; D002648:Child; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007010:Hyponatremia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D007038:Hypotonic Solutions / Q000008:administration & dosage* / Q000009:adverse effects; D007262:Infusions, Intravenous; D007552:Isotonic Solutions / Q000008:administration & dosage* / Q000009:adverse effects; D009481:Neurophysins / Q000378:metabolism; D019990:Perioperative Care / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D011498:Protein Precursors / Q000378:metabolism; D012307:Risk Factors; D016896:Treatment Outcome; D014667:Vasopressins / Q000378:metabolism; D014882:Water-Electrolyte Balance
chemical_list: C438657:AVP protein, human; D007038:Hypotonic Solutions; D007552:Isotonic Solutions; D009481:Neurophysins; D011498:Protein Precursors; D014667:Vasopressins
keywords: Hyponatremia; Hypotonic; Intravenous maintenance fluid; Isotonic; Perioperative; Postoperative