Intravenous postoperative fluid prescriptions for children: A survey of practice

Abstract

BackgroundPostoperative deaths and neurological injury have resulted from hyponatraemia associated with the use of hypotonic saline solutions following surgery. We aimed to determine the rates and types of intravenous fluids being prescribed postoperatively for children in the UK.MethodsA questionnaire was sent to members of the British Association of Paediatric Surgeons (BAPS) and Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI) based at UK paediatric centres. Respondents were asked to prescribe postoperative fluids for scenarios involving children of different ages. The study period was between May 2006 and November 2006.ResultsThe most frequently used solution was sodium chloride 0.45% with glucose 5% although one quarter of respondents still used sodium chloride 0.18% with glucose 4%. Isotonic fluids were used by 41% of anaesthetists and 9.8% of surgeons for the older child, but fewer for infants. Standard maintenance rates or greater were prescribed by over 80% of respondents.ConclusionMost doctors said they would prescribe hypotonic fluids at volumes equal to or greater than traditional maintenance rates at the time of the survey. A survey to describe practice since publication of National Patient Safety Agency (NPSA) recommendations is required.

A Phase I Pharmacokinetic and Pharmacodynamic Study of TKI258, an Oral, Multitargeted Receptor Tyrosine Kinase Inhibitor in Patients with Advanced Solid Tumors

“…After Holliday and Segar made recommendations for maintenance fluid in children, 1 hypotonic fluids are still the most commonly prescribed IV fluids for pediatric hospitalized patients. [2][3][4] Their hypotonic formula was based on the energy expenditure of healthy children and the composition of human breast and cow milk. 1 Hypotonic fluids according to their recommendations may be appropriate for healthy children.…”

The relationship between arginine vasopressin levels and hyponatremia following a percutaneous renal biopsy in children receiving hypotonic or isotonic intravenous fluids

“…Hypotonic fluid administration results in a fall in serum sodium level in the presence of elevated AVP levels, while 0.9% NaCl effectively prevents a fall in serum sodium level. The administration of hypotonic fluids post-operatively is a common practice, occurring in over 80% of children [1,[16][17][18]. The safety of this approach in the post-operative setting has been questioned as it has been associated with numerous cases of death or permanent neurological dysfunction [5,7,8].…”

A Case of Difficult Management of Fluid-electrolyte Imbalance in Choroid Plexus Papilloma

“…3) CSF is an isotonic fluid with an approximate sodium concentration of 138 mmol/L, but the potassium content of CSF is 2.8 mmol/L, which is less than that of extracellular fluid (4.5 mmol/L). 8) To date, hypotonic saline with a physiologic potassium supplement has been widely used as maintenance fluid in pediatrics; 3,9) however, many recent studies have criticized this tradition of prescribing hypotonic saline for sick children because of the risk of developing iatrogenic hyponatremia, which is often fatal. 3,10,11) In the present case, our first strategy of tumor removal after correction of the fluid-electrolyte balance might be questionable as a result.…”