title: Hypotonic fluid reduce serum sodium compared to isotonic fluids during anesthesia induction in pediatric patients undergoing maxillofacial surgery-type of infusion affects blood electrolytes and glucose: an observational study.
abstract: Reportedly, administration of hypotonic fluids containing 30.8-74 mEq/L sodium with 5 % glucose may lead to serious hyponatremia or hyperglycemia. In Japan, hypotonic fluids containing 90 mEq/L sodium with 2.6 % glucose are commonly used. We compared blood electrolyte balance and blood glucose concentration with the use of isotonic (140 mEq/L sodium with 1 % glucose) versus hypotonic fluids in pediatric patients.
  
  
  
  We studied 77 children aged 5 months to 2 years who underwent oro-maxillofacial surgery and dental treatment under general anesthesia. Patients were categorized according to the fluids infused (hypotonic or isotonic). Blood samples were obtained from the dorsalis pedis artery between the conclusion of anesthesia induction and commencement of surgery. We compared blood sodium, potassium and glucose concentrations in the two fluid groups during the pre-anesthesia and post-anesthesia-induction periods.
  
  
  
  There were no significant differences in pre-anesthesia values between isotonic (n = 35) and hypotonic groups (n = 42). There were significant differences between isotonic and hypotonic groups in post-anesthesia-induction concentrations of sodium (isotonic, 138.7 ± 1.4 mEq/L; hypotonic, 137.5 ± 1.3 mEq/L; p = 0.0003) and glucose (isotonic, 88.0 ± 9.4 mg/dL; hypotonic, 109.9 ± 18.4 mg/dL; p < 0.0001), while potassium concentrations were not significantly different (isotonic, 4.0 ± 0.3 mEq/L; hypotonic, 4.0 ± 0.2 mEq/L; p = 0.6615) between the two groups.
  
  
  
  Isotonic solution administration enables avoidance of serum sodium reduction and serum glucose elevation in infants, and may therefore enhance patient safety in comparison with hypotonic solutions.
  
  
  
  University Hospital Medical Information Network Clinical Trials Registry ( UMIN000014648 ), registration 25 July 2014.
authors.affiliation: Department of Dental Anesthesiology, Field of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University Graduate School, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. ken2006anes@yahoo.co.jp.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Ouchi
authors.affiliation: Department of Dental Anesthesiology, Field of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University Graduate School, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors.forename: Kazuna
authors.initials: K
authors.lastname: Sugiyama
mesh_terms: D000768:Anesthesia, General; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D002675:Child, Preschool; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects* / Q000379:methods; D005947:Glucose / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D007038:Hypotonic Solutions; D007223:Infant; D007552:Isotonic Solutions; D008297:Male; D019647:Oral Surgical Procedures; D011300:Preoperative Care / Q000009:adverse effects* / Q000379:methods; D057234:Preoperative Period; D012964:Sodium / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D014882:Water-Electrolyte Balance; D014883:Water-Electrolyte Imbalance / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D007038:Hypotonic Solutions; D007552:Isotonic Solutions; D012964:Sodium; D005947:Glucose
keywords: General Anesthesia; Hyperglycemia; Hyponatremia; Hypotonic solutions; Isotonic solutions