Effect of Intravenous Fluid on Perioperative Plasma Sodium Concentration in Paediatric Surgical Patients

Abstract

Background: There have been various publications on the risk of developing iatrogenic hyponatraemia following intravenous fluid administration in the pediatric age group. The aim of this study was to determine the suitable maintenance fluid that sustains normal plasma sodium levels in children in the perioperative period by comparing 4.3% dextrose in 0.18% saline with Ringer’s lactate when either is administered as maintenance fluid. Method: This study was carried out at the paediatric surgery unit of the Obafemi Awolowo University Teaching Hospital, Ile Ife, Nigeria between 1st September 2014 and 31st October 2015. This study is a comparative prospective study. There were 25 children in each group. One group received 4.3% dextrose in 0.18% saline, while the other group received Ringer’s lactate as maintenance fluid in the perioperative period. Serial blood and urine samples were collected before, during and after the surgery up till the first 24 hours. These samples were analyzed for sodium and creatinine concentration. Fractional excretion of sodium was calculated. Results were analyzed using SPSS software version 22. Results: There was no statistical significant difference between the two groups (p0.49) in term of age. The proportion of patients that developed hyponatraemia in the group that received hypotonic fluid was 32% (8/25), while it was 8% (2/25) in the group that received isotonic fluid (p=0.034). The patients who received Ringer’s lactate as maintenance fluid also had a higher mean plasma sodium concentration during the study. Conclusion: Ringer’s lactate was found to be a better fluid in terms of preventing hyponatraemia in children who are five years and below during the perioperative period compared to 4.3% dextrose in 0.18% normal saline.