Key result
Hypotonic parenteral maintenance solution significantly increased the risk of acute postoperative hyponatremia compared with isotonic solution (40.8% vs 22.7%; RR 1.82; 95% CI 1.21-2.74; P=.004).
Why the study?
Does hypotonic parenteral maintenance solution increase the risk of acute hyponatremia compared to isotonic solution in postoperative pediatric patients?
RCT (n=258)
Fully blinded
Randomized
Does hypotonic parenteral maintenance solution increase the risk of acute hyponatremia compared to isotonic solution in postoperative pediatric patients?
Relative Risk: 1.82 (95% CI 1.21–2.74)
Absolute Event Rate: 40.8% vs 22.7%
p-value: p=.004
Isotonic maintenance fluids are significantly safer than hypotonic fluids in protecting against acute postoperative hyponatremia in children.
Isotonic maintenance fluids should be preferred postoperatively in children; confirms randomized evidence for reduced hyponatremia risk versus hypotonic solutions.
OBJECTIVE: The objective of this randomized controlled trial was to evaluate the risk of hyponatremia following administration of a isotonic (0.9% saline) compared to a hypotonic (0.45% saline) parenteral maintenance solution (PMS) for 48 hours to postoperative pediatric patients. METHODS: Surgical patients 6 months to 16 years of age with an expected postoperative stay of >24 hours were eligible. Patients with an uncorrected baseline plasma sodium level abnormality, hemodynamic instability, chronic diuretic use, previous enrollment, and those for whom either hypotonic PMS or isotonic PMS was considered contraindicated or necessary, were excluded. A fully blinded randomized controlled trial was performed. The primary outcome was acute hyponatremia. Secondary outcomes included severe hyponatremia, hypernatremia, adverse events attributable to acute plasma sodium level changes, and antidiuretic hormone levels. RESULTS: A total of 258 patients were enrolled and assigned randomly to receive hypotonic PMS (N = 130) or isotonic PMS (N = 128). Baseline characteristics were similar for the 2 groups. Hypotonic PMS significantly increased the risk of hyponatremia, compared with isotonic PMS (40.8% vs 22.7%; relative risk: 1.82 [95% confidence interval: 1.21-2.74]; P = .004). Admission to the pediatric critical care unit was not an independent risk factor for the development of hyponatremia. Isotonic PMS did not increase the risk of hypernatremia (relative risk: 1.30 [95% confidence interval: 0.30-5.59]; P = .722). Antidiuretic hormone levels and adverse events were not significantly different between the groups. CONCLUSION: Isotonic PMS is significantly safer than hypotonic PMS in protecting against acute postoperative hyponatremia in children.
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Choong et al. (2011) conducted an RCT in Postoperative pediatric patients (n=258). Hypotonic (0.45% saline) parenteral maintenance solution vs. Isotonic (0.9% saline) parenteral maintenance solution was evaluated on acute hyponatremia (RR 1.82, 95% CI 1.21-2.74, p=.004). Hypotonic parenteral maintenance solution significantly increased the risk of acute postoperative hyponatremia compared with isotonic solution (40.8% vs 22.7%; RR 1.82; 95% CI 1.21-2.74; P=.004).