[Parenteral fluid therapy in the pediatric surgical patient].

Perioperative fluid therapy aims to provide water, electrolytes and calorie to maintain metabolic homeostasis. The landmark article in which Holliday and Segar proposed the rate and composition of parenteral maintenance fluids for hospitalized children is used to the fluid management for the pediatric surgical patient. Critically ill patients require meticulous intraoperative fluid management to avoid acidosis, hypoglycemia, hyponatremia, and hypocalcemia as well as to maintain adequate intravascular volume. The glucose, electrolyte, and intravascular volume requirements of the pediatric surgical patient may be quite different from the original population described, and consequently, use of traditional hypotonic fluids may cause complications, such as hyperglycemia and hyponatremia in the postoperative surgical patient. Routine intraoperative dextrose administration is no longer necessary. We should ultimately change our approach according to major intraoperative fluid shifts by rational, monitored, goal-directed combination of both crystalloid and colloid therapy, similar to that occurring in adult surgical patients.