Inappropriate secretion of antidiuretic hormone in a postsurgical pediatric population

Burrows, Frederick A.; Shutack, John G.; Crone, Robert K.

doi:10.1097/00003246-198307000-00009

Cited by 102 publications

(68 citation statements)

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“…Uma significante correlação entre ganho de água livre e diminuição de sódio plasmático tem sido demonstrada 36 , e a fonte primária de água livre é a administração exógena de fluidos hipotônicos 28,37 . A revisão sistemática realizada por Marthur et al 30 comparando soluções isotônicas e hipotônicas em crianças com infecções agudas não conseguiu responder a essa pergunta.…”

Section: Discussionunclassified

Isotonic saline solution as maintenance intravenous fluid therapy to prevent acquired hyponatremia in hospitalized children

Alves¹,

Troster²,

Oliveira³

2011

J Pediatr (Rio J)

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Objectives: This review aims to evaluate if the use of hypotonic saline solutions as maintenance intravenous fluid therapy in hospitalized children increases the risk of hyponatremia, if the administration of isotonic fluids is able to protect against acquired hyponatremia and if the isotonic solutions increase the risks of deleterious effects such as hypernatremia or fluid overload. Sources:We researched the relevant literature on the PubMed (Jan 01 1969 to Jul 13 2011), EMBASE (1989to 2011) and Cochrane Library (1989to 2011 databases. Furthermore, references of selected studies were included. Summary of the findings:Hospitalized children are potentially at risk of developing hyponatremia and the use of hypotonic saline solutions is the main risk factor for this disease. Isotonic saline solutions have shown a protective effect against hyponatremia, and, so far, there have been no significant deleterious effects such as fluid overload, hypernatremia or phlebitis. Conclusions:The evidence found indicates that the traditional recommendation of Holliday and Segar to use maintenance fluid therapy for sick and hospitalized children deserves to be reconsidered due to the adverse effects found to arise from it, apart from the better results obtained by using isotonic solutions.J Pediatr (Rio J). 2011;87(6):478-86: Isotonic solutions, hypotonic solutions, fluid therapy, hyponatremia, child, hospitalization. ResumoObjetivos: Avaliar se o uso de soluções salinas hipotônicas como fluidoterapia de manutenção em crianças hospitalizadas aumenta o risco de hiponatremia, se a administração de fluidos isotônicos é capaz de proteger contra a hiponatremia adquirida e se as soluções isotôni-cas aumentam os riscos de efeitos deletérios como hipernatremia ou sobrecarga hídrica. Síntese dos dados:Crianças hospitalizadas têm riscos potenciais para hiponatremia, e o uso de soluções salinas hipotônicas é o principal fator de risco para esse agravo. As soluções salinas isotônicas têm mostrado efeito protetor para hiponatremia e, até o momento, sem efeitos deletérios significativos, como sobrecarga hídrica, hipernatremia ou flebites. Conclusões:As evidências indicam que a tradicional recomendação de Holliday & Segar quanto à fluidoterapia de manutenção para crianças doentes e hospitalizadas merece ser reconsiderada em virtude das evidên-cias sobre os efeitos adversos dela advindos, assim como dos melhores resultados obtidos com o emprego das soluções isotônicas. J Pediatr (Rio J) IntroduçãoA hiponatremia é definida como a concentração do sódio sérico inferior a 136 mmol/L. Quando sintomático, esse distúrbio pode manifestar-se por disfunção do sistema nervoso central (SNC), caracterizado por: cefaleia, náuseas, vômitos, letargia, desorientação, depressão de reflexos tendinosos, convulsões, disfunção neurológica permanente, morte por

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Section: Discussionunclassified

Isotonic saline solution as maintenance intravenous fluid therapy to prevent acquired hyponatremia in hospitalized children

Alves¹,

Troster²,

Oliveira³

2011

J Pediatr (Rio J)

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“…ADH levels peak 6-12 h after surgery with a gradual return to baseline over the subsequent 5 days [21,22]. Not surprisingly, Choong et al found that among 258 children undergoing elective surgery, 80 % of those who developed postoperative hyponatremia did so in the first 24 postoperative hours [23].…”

Section: Non-osmotic Stimuli For Antidiuretic Hormonementioning

confidence: 99%

Perioperative fluid management and postoperative hyponatremia in children

Sutherland

2015

Pediatr Nephrol

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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 hospitalacquired 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.

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“…1,5,8,10 Kadar HAD pasca-operasi akan meningkat sebagai respon stres hormonal yang fisiologis, tetapi pada beberapa orang sekresi HAD dapat terjadi secara berlebihan sehingga menyebabkan SHATT. 5,11,12 Stimulus non osmotik, seperti nyeri, mual, muntah, hipoksia, asidosis, dan penggunaan beberapa jenis obat anestesia dapat secara poten merangsang sekresi HAD. 5,13,14 Terapi cairan yang tepat pada pasien pascaoperasi sampai sekarang masih menjadi kontroversi.…”

Section: Hiponatremia Pada Anak Pasca Tindakan Operasi : Etiologi Danunclassified

“…Total balans cairan positif sebagai faktor yang berhubungan dengan kejadian hiponatremia juga tidak didapatkan dalam penelitian ini. 6,12,30 Salah satu mekanisme yang berperan dalam menyebabkan terjadinya hiponatremia adalah hiponatremia translokasional, yang terjadi pada kondisi SCS.…”

Section: Pembahasanunclassified

Hiponatremia pada Anak Pasca Tindakan Operasi : Etiologi dan Faktor-faktor yang Berhubungan

Arifin¹,

Pudjiadi²,

Handryastuti³

et al. 2017

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Latar belakang. Kejadian hiponatremia pada anak pasca-operasi berkisar antara 20-40%. Hiponatremia yang tidak terdeteksi dapat meningkatkan mortalitas dan menyebabkan luaran neurologis yang buruk. Beberapa mekanisme yang berperan adalah sindrom hormon antidiuretik tidak tepat (SHATT) dan sick cell syndrome (SCS). Tujuan. Mengetahui insidens hiponatremia pada anak pasca-operasi, kemungkinan penyebab yang melatarbelakangi, serta faktor yang berhubungan. Metode. Penelitian potong lintang analitik dilakukan di ruang perawatan intensif terhadap anak berusia 1 bulan sampai 18 tahun yang menjalani tindakan operasi mayor dan masuk ruang perawatan intensif pediatrik RSCM selama bulan Mei sampai Desember 2016. Hasil. Terdapat 65 subyek menjalani operasi mayor, 87,69% dilakukan secara elektif, jenis operasi terbanyak adalah hepatogastrointestinal (38,46%) dan muskuloskeletal (20,00%). Kadar natrium plasma pasca-operasi turun, kejadian hiponatremia 43,07% dan 26,16% pada 12 dan 24 jam pasca-operasi. Nilai osmolalitas plasma yang normal atau meningkat dan osmolalitas urin >100 mOsm/kg. Sebanyak 70% subyek hiponatremia memiliki natrium urin >30 mEq/L. Faktor yang berhubungan dengan hiponatremia 12 jam pasca-operasi adalah status kegawatdaruratan operasi (p=0,007) dan perdarahan intraoperatif (p=0,024), sedangkan pada 24 jam pasca-operasi hanya status kegawatdaruratan operasi (p=0,001). Kesimpulan. Terdapat 43,07% dan 26,16% subyek yang mengalami hiponatremia pada 12 dan 24 jam pasca-operasi mayor. Sindrom hormon antidiuretik tidak tepat tidak terbukti menjadi penyebab utama terjadinya hiponatremia, dan hiponatremia translokasional pada SCS mungkin berperan. Hiponatremia pasca-operasi berhubungan dengan status kegawatdaruratan operasi dan jumlah perdarahan intraoperatif. Sari Pediatri 2017;19(2):63-70Kata kunci: hiponatremia, pasca-operasi, hormon antidiuretik, sick cell sydrome Hyponatremia in Post-surgery Pediatric Patients: Etiology and Its Related FactorsAngelina, Antonius H. Pudjiadi, Setyo Handryastuti, Idham Amir, Evita B. Ifran, Mulya R. KaryantiBackground. The incidence of hyponatremia in post-surgery pediatric patients is 20-40%. Undetected hyponatremia correlates with higher mortality and poor neurology outcomes. There are several mechanisms in post-surgery hyponatremia, such as syndrome of inappropriate antidiuretic hormone and sick cell syndrome. Objective. To establish the incidence of hyponatremia among post-surgery pediatric patients, possible etiologies, and its related factors. Method. Observational analytic study was conducted forchildren aged 1 month until 18 years old after underwent major surgery in CM hospital pediatric intensive care unit, between May and December 2016. Results. There were 65 subjects underwent mayor surgery, mostly (87.69%) were elective surgery. The most common surgeries were hepato-gastrointestinal (38,46%) and musculoskeletal (20,00%) surgery. There was significant reductionof plasma natrium after surgery, with hyponatremia incidence at 12 and 24 hours post-surgery were 43.07% and 2...

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Inappropriate secretion of antidiuretic hormone in a postsurgical pediatric population

Cited by 102 publications

References 0 publications

Isotonic saline solution as maintenance intravenous fluid therapy to prevent acquired hyponatremia in hospitalized children

Isotonic saline solution as maintenance intravenous fluid therapy to prevent acquired hyponatremia in hospitalized children

Perioperative fluid management and postoperative hyponatremia in children

Hiponatremia pada Anak Pasca Tindakan Operasi : Etiologi dan Faktor-faktor yang Berhubungan

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