Evaluation of current paediatric guidelines for fluid therapy using two different dextrose hydrating solutions

Abstract

Simplified guidelines for intra‐operative fluid therapy were evaluated in two groups of children (aged 3 months‐10 years) undergoing minor non‐haemorrhagic surgical procedures, randomly assigned to receive either 5% or 2.5% dextrose in 0.3% or 0.4% normal (N) saline. Blood samples were obtained at the time of induction and upon arrival in the recovery room. Fasting time was on average greater than 10 h and hypoglycaemia, defined as blood glucose less than 3.5 mmol?l−1, was observed in 7.4% of the children at the time of induction. In both groups, blood glucose increased at the end of surgery, this increase being more significant in children receiving 5% dextrose than in those receiving 2.5% dextrose. In both groups, post‐operative blood glucose values were higher in children of less than 4 years of age than in those aged 4 and over. Blood glucose changes were associated with a decrease in plasma sodium, this decrease being greater in children receiving 5% dextrose in 0.3 N saline, especially in those less than 4 years of age. This study suggests that the use of a 5% dextrose hydrating solution in 0.3 N saline is more likely to result in hyperglycaemia and hyponatraemia than a 2.5% dextrose in a 0.4 N saline, particularly in children younger than 4 years of age.