Effect of Intravenous Fluid on Perioperative Plasma Sodium Concentration in Pediatric Surgical Patients

Background: The aim of this study was to determine the suitable maintenance fluid that sustains normal plasma sodium levels in children that are 5 years and below in the perioperative period by comparing 4.3% dextrose in 0.18% saline with Ringer’s lactate when either is administered as maintenance fluid. Materials and Methods: This comparative prospective study was carried out at the pediatric surgery unit of the Obafemi Awolowo University Teaching Hospital, Ile Ife, Nigeria between September 2014 and October 2015. 50 patients were enrolled, 25 in each group. One group received 4.3% dextrose in 0.18% saline, while the other group received Ringer’s lactate as maintenance fluid in the perioperative period. Serial blood and urine samples were collected before, during and after the surgery up till the first 24 hours after surgery. These samples were analyzed for concentration of sodium and creatinine. Fractional excretion of sodium was calculated. Data were analyzed using SPSS software (version 22.0). Results: The mean age of the study population was 30.6+19.33 months. The mean age of the patients on dextrose saline and Ringer’s lactate was 28.72+20.3 32.52+18.53 months, respectively (p=0.49). The proportion of patients that developed hyponatraemia in the group that received hypotonic fluid was 32% (8/25), while it was 8% (2/25) in the group that received isotonic fluid (p=0.034). The patients who received Ringer’s lactate as maintenance fluid also had a higher mean plasma sodium concentration during the study. Conclusion: Ringer’s lactate was found to be a better fluid in terms of preventing hyponatraemia in children who are five years and below during the perioperative period compared to 4.3% dextrose in 0.18% normal saline.