Department of Pediatric and Neonatal Surgery, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal.
Department of Pediatric Surgery, Christian Medical College, Vellore 632 002 Tamilnadu, India.
JNMA J Nepal Med Assoc. 2021 Nov 15;59(243):1131-1135. doi: 10.31729/jnma.7133.
Hypotonic solutions in postoperative children may cause hyponatremia. Considering humidity and temperatures in India, this study was conducted to find out the prevalence of hyponatremia among postoperative children who were administered with hypotonic solutions in a tertiary care hospital.
A descriptive cross-sectional study was conducted at a tertiary care hospital. Ethical approval was taken from the institutional review board of Christian Medical College, Vellore, India (Reference number: 9177). Children aged less than 15 years undergoing elective surgery, requiring fasting for more than 12 hours post-operatively with normal preoperative electrolytes and renal functions were included. Hypotonic fluids were administered following existent protocol. Electrolytes were repeated immediate postoperatively and at 12-24 hours. Data was entered into and analyzed using the Statistical Package for the Social Sciences version 18.0. Point estimate at 90% Confidence Interval was calculated along with frequency and proportion for binary data.
Among 109 participants, hyponatremia in the postoperative period was seen in 53 (48.6%) (40.7-56.5 at 90% Confidence Interval) children. Hyponatremia was found in the immediate postoperative period in 10 (9.2%) children. All received Ringer Lactate as maintenance intra-operatively and none were severe enough to need correction. In the 12-24-hour sample, 43 (39.41%) had hyponatremia and none in severe category.
Asymptomatic hyponatremia was noted in normal children planned for elective surgery. Among children managed with the existing institutional perioperative (hypotonic) fluid management protocol, subclinical postoperative hyponatremia within 12-24 hours of surgery was noted in a significant proportion, which was more in the hot and warm months in tropics. There are grounds for switching to isotonic fluids for perioperative management.
术后儿童输入低张溶液可能导致低钠血症。考虑到印度的湿度和温度，本研究旨在调查在一家三级保健医院接受低张溶液治疗的术后儿童中低钠血症的患病率。
在一家三级保健医院进行描述性横断面研究。印度维洛尔基督教医学院机构审查委员会（参考号：9177）已批准该研究。纳入年龄小于 15 岁、接受择期手术、术后禁食超过 12 小时、术前电解质和肾功能正常的儿童。根据现有方案给予低张液体。术后即刻和 12-24 小时重复电解质。使用社会科学统计软件包 18.0 输入和分析数据。计算 90%置信区间的点估计值，以及二进制数据的频率和比例。
在 109 名参与者中，53 名（48.6%）（90%置信区间为 40.7-56.5）术后儿童出现低钠血症。10 名（9.2%）儿童在术后即刻出现低钠血症。所有患儿术中均接受乳酸林格氏液维持治疗，均无需严重纠正。在 12-24 小时样本中，43 名（39.41%）有低钠血症，无严重病例。
计划接受择期手术的正常儿童出现无症状性低钠血症。在接受现有机构围手术期（低张）液体管理方案管理的儿童中，在术后 12-24 小时内观察到相当比例的亚临床术后低钠血症，在热带地区炎热和温暖的月份更为常见。有理由在围手术期管理中改用等渗液。
