Yokota Kazuki, Uchida Hiroo, Manaka Katsunori, Nangaku Masaomi, Kuwatsuka Yachiyo, Ando Masahiko, Nishiwaki Kimitoshi, Hirai Takahiro, Tainaka Takahisa, Shirota Chiyoe, Sumida Wataru, Makita Satoshi, Amano Hizuru, Hinoki Akinari
Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Division of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan.
Pediatr Res. 2025 May 21. doi: 10.1038/s41390-025-04124-8.
We examined the underlying mechanisms of whether hyponatremia could be induced by hypotonic solution administration after the postoperative invasive phase (POIP).
We included patients who had undergone surgery with expected oral feeding resumption after postoperative day (POD) 3. In this open-label, randomized controlled trial, 100 patients were assigned to three groups by sodium concentrations ([Na]) used for maintenance infusions: 136 mEq/L (ISO) (n = 34), 68 mEq/L (HYPO) (n = 33), and 34 mEq/L (exHYPO) (n = 33). Potassium (20 mEq/L) and glucose (60 g/L) were added to each infusion. Ringer's solution was used in all groups for the first 12 h postoperatively, then switched to a maintenance solution. Blood samples were drawn and evaluated on POD 3.
Hyponatremia frequencies on POD 3 were 3.6, 18, and 39% in the ISO, HYPO, and exHYPO groups, respectively, with a significant difference between the ISO and exHYPO groups. Additionally, 90% of the patients still had excessive antidiuretic hormone (ADH) secretion on POD 3. There were no remarkable adverse events.
The persistence of surgical stress-induced ADH secretion until POD 3 suggested that hyponatremia was induced by exHYPO administration. However, using Ringer's solution during the POIP might prevent hyponatremia in HYPO patients.
UMIN000029057 ( https://www.umin.ac.jp/ctr/index.htm ).
01/11/2017 IMPACT: After the postoperative invasive phase, non-osmotic antidiuretic hormone (ADH) secretion due to surgical stress persisted, resulting in an excess ADH state for at least 3 postoperative days (PODs). Administration of extremely hypotonic electrolyte infusions under such circumstances might induce hyponatremia. Adequate extracellular fluid administration during the invasive phase after major pediatric laparoscopic surgery did not cause further increases in ADH secretion or hyponatremia, even for HYPO maintenance fluid.
我们研究了术后侵袭期（POIP）后给予低渗溶液是否会诱发低钠血症的潜在机制。
我们纳入了预计术后第3天（POD）后恢复经口喂养的手术患者。在这项开放标签的随机对照试验中，100名患者根据维持输液所用的钠浓度（[Na]）被分为三组：136 mEq/L（等渗组，ISO）（n = 34）、68 mEq/L（低渗组，HYPO）（n = 33）和34 mEq/L（极低渗组，exHYPO）（n = 33）。每组输液中均添加钾（20 mEq/L）和葡萄糖（60 g/L）。所有组术后前12小时使用林格氏液，然后换用维持液。在POD 3采集血样并进行评估。
POD 3时，ISO组、HYPO组和exHYPO组的低钠血症发生率分别为3.6%、18%和39%，ISO组和exHYPO组之间存在显著差异。此外，90%的患者在POD 3时仍有抗利尿激素（ADH）分泌过多的情况。未出现明显不良事件。
手术应激诱导的ADH分泌持续至POD 3，提示exHYPO输液诱发了低钠血症。然而，在POIP期间使用林格氏液可能预防HYPO患者发生低钠血症。
UMIN000029057（https://www.umin.ac.jp/ctr/index.htm）。
2017年11月1日 影响：术后侵袭期后，手术应激导致的非渗透性抗利尿激素（ADH）分泌持续存在，导致术后至少3天（PODs）处于ADH分泌过多状态。在这种情况下给予极低渗电解质输液可能诱发低钠血症。即使对于HYPO维持液，小儿大型腹腔镜手术后侵袭期给予充足的细胞外液也不会导致ADH分泌进一步增加或低钠血症。
