Hiponatremia associada a fluidoterapia endovenosa em pacientes pediátricos hospitalizados : estudo prospectivo randomizado

Abstract

Objective: To evaluate the occurrence of hyponatremia in hospitalized pediatric patients comparing the use of maintenance isotonic and hypotonic solution. Methods: A prospective randomized clinical study was performed including 50 patients who underwent appendectomy surgery. The patients were randomized to receive isotonic (isotonic group) or hypotonic (hypotonic group) solution with a daily volume of 2000 ml/m². The concentration of electrolytes, glucose, urea and creatinine was measured at baseline, 24 hours and 48 hours after surgery. The volume infused (before, during, after 24 and 48 hours from surgery), diuresis, weight and fluid balance were also analyzed. Results: Twenty-four (49%) infants had hyponatremia at baseline and 17 remained hyponatraemic 48 hours after surgery. Sodium levels in 48 h postoperative in the isotonic group were 136.6 ± 2.7 and 136.2 ± 2.3 hypotonic group, without statistically significant difference. In both groups sodium levels increased in the 24th post operative hour (137.4 ± 2.2 and 137.0 ± 2.7), with no difference between groups (p = 0.593). The volumes infused and diuresis did not differ between groups in the three stages of the study. The water balance was higher in the period prior to surgery in patients who received hypotonic solution (p = 0.021). Conclusions: The administration of hypotonic solution did not increase the risk of hyponatremia compared to isotonic saline in postoperative appendectomy patients. The water balance in the preoperative period was significantly higher in patients who received hypotonic solution.