Hypotonic fluid reduce serum sodium compared to isotonic fluids during anesthesia induction in pediatric patients undergoing maxillofacial surgery-type of infusion affects blood electrolytes and glucose

An observational study

Kentaro Ouchi, Kazuna Sugiyama

Research output: Contribution to journalArticle

Abstract

Background: Reportedly, administration of hypotonic fluids containing 30.8-74 mEq/L sodium with 5 % glucose may lead to serious hyponatremia or hyperglycemia. In Japan, hypotonic fluids containing 90 mEq/L sodium with 2.6 % glucose are commonly used. We compared blood electrolyte balance and blood glucose concentration with the use of isotonic (140 mEq/L sodium with 1 % glucose) versus hypotonic fluids in pediatric patients. Methods: We studied 77 children aged 5 months to 2 years who underwent oro-maxillofacial surgery and dental treatment under general anesthesia. Patients were categorized according to the fluids infused (hypotonic or isotonic). Blood samples were obtained from the dorsalis pedis artery between the conclusion of anesthesia induction and commencement of surgery. We compared blood sodium, potassium and glucose concentrations in the two fluid groups during the pre-anesthesia and post-anesthesia-induction periods. Results: There were no significant differences in pre-anesthesia values between isotonic (n = 35) and hypotonic groups (n = 42). There were significant differences between isotonic and hypotonic groups in post-anesthesia-induction concentrations of sodium (isotonic, 138.7 ± 1.4 mEq/L; hypotonic, 137.5 ± 1.3 mEq/L; p = 0.0003) and glucose (isotonic, 88.0 ± 9.4 mg/dL; hypotonic, 109.9 ± 18.4 mg/dL; p < 0.0001), while potassium concentrations were not significantly different (isotonic, 4.0 ± 0.3 mEq/L; hypotonic, 4.0 ± 0.2 mEq/L; p = 0.6615) between the two groups. Conclusion: Isotonic solution administration enables avoidance of serum sodium reduction and serum glucose elevation in infants, and may therefore enhance patient safety in comparison with hypotonic solutions. Trial registration: University Hospital Medical Information Network Clinical Trials Registry ( UMIN000014648 ), registration 25 July 2014.

Original languageEnglish
Article number112
Number of pages1
JournalBMC Pediatrics
Volume16
Issue number1
DOIs
Publication statusPublished - Jul 27 2016

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Oral Surgery
Electrolytes
Observational Studies
Blood Glucose
Anesthesia
Sodium
Pediatrics
Glucose
Serum
Potassium
Hypotonic Solutions
Isotonic Solutions
Water-Electrolyte Balance
Information Services
Hyponatremia
Patient Safety
Hyperglycemia
General Anesthesia
Registries
Tooth

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

Cite this

@article{dc08bbcf6fcc4dfb936eac9719c7e359,
title = "Hypotonic fluid reduce serum sodium compared to isotonic fluids during anesthesia induction in pediatric patients undergoing maxillofacial surgery-type of infusion affects blood electrolytes and glucose: An observational study",
abstract = "Background: Reportedly, administration of hypotonic fluids containing 30.8-74 mEq/L sodium with 5 {\%} glucose may lead to serious hyponatremia or hyperglycemia. In Japan, hypotonic fluids containing 90 mEq/L sodium with 2.6 {\%} glucose are commonly used. We compared blood electrolyte balance and blood glucose concentration with the use of isotonic (140 mEq/L sodium with 1 {\%} glucose) versus hypotonic fluids in pediatric patients. Methods: We studied 77 children aged 5 months to 2 years who underwent oro-maxillofacial surgery and dental treatment under general anesthesia. Patients were categorized according to the fluids infused (hypotonic or isotonic). Blood samples were obtained from the dorsalis pedis artery between the conclusion of anesthesia induction and commencement of surgery. We compared blood sodium, potassium and glucose concentrations in the two fluid groups during the pre-anesthesia and post-anesthesia-induction periods. Results: There were no significant differences in pre-anesthesia values between isotonic (n = 35) and hypotonic groups (n = 42). There were significant differences between isotonic and hypotonic groups in post-anesthesia-induction concentrations of sodium (isotonic, 138.7 ± 1.4 mEq/L; hypotonic, 137.5 ± 1.3 mEq/L; p = 0.0003) and glucose (isotonic, 88.0 ± 9.4 mg/dL; hypotonic, 109.9 ± 18.4 mg/dL; p < 0.0001), while potassium concentrations were not significantly different (isotonic, 4.0 ± 0.3 mEq/L; hypotonic, 4.0 ± 0.2 mEq/L; p = 0.6615) between the two groups. Conclusion: Isotonic solution administration enables avoidance of serum sodium reduction and serum glucose elevation in infants, and may therefore enhance patient safety in comparison with hypotonic solutions. Trial registration: University Hospital Medical Information Network Clinical Trials Registry ( UMIN000014648 ), registration 25 July 2014.",
author = "Kentaro Ouchi and Kazuna Sugiyama",
year = "2016",
month = "7",
day = "27",
doi = "10.1186/s12887-016-0650-6",
language = "English",
volume = "16",
journal = "BMC Pediatrics",
issn = "1471-2431",
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T1 - Hypotonic fluid reduce serum sodium compared to isotonic fluids during anesthesia induction in pediatric patients undergoing maxillofacial surgery-type of infusion affects blood electrolytes and glucose

T2 - An observational study

AU - Ouchi, Kentaro

AU - Sugiyama, Kazuna

PY - 2016/7/27

Y1 - 2016/7/27

N2 - Background: Reportedly, administration of hypotonic fluids containing 30.8-74 mEq/L sodium with 5 % glucose may lead to serious hyponatremia or hyperglycemia. In Japan, hypotonic fluids containing 90 mEq/L sodium with 2.6 % glucose are commonly used. We compared blood electrolyte balance and blood glucose concentration with the use of isotonic (140 mEq/L sodium with 1 % glucose) versus hypotonic fluids in pediatric patients. Methods: We studied 77 children aged 5 months to 2 years who underwent oro-maxillofacial surgery and dental treatment under general anesthesia. Patients were categorized according to the fluids infused (hypotonic or isotonic). Blood samples were obtained from the dorsalis pedis artery between the conclusion of anesthesia induction and commencement of surgery. We compared blood sodium, potassium and glucose concentrations in the two fluid groups during the pre-anesthesia and post-anesthesia-induction periods. Results: There were no significant differences in pre-anesthesia values between isotonic (n = 35) and hypotonic groups (n = 42). There were significant differences between isotonic and hypotonic groups in post-anesthesia-induction concentrations of sodium (isotonic, 138.7 ± 1.4 mEq/L; hypotonic, 137.5 ± 1.3 mEq/L; p = 0.0003) and glucose (isotonic, 88.0 ± 9.4 mg/dL; hypotonic, 109.9 ± 18.4 mg/dL; p < 0.0001), while potassium concentrations were not significantly different (isotonic, 4.0 ± 0.3 mEq/L; hypotonic, 4.0 ± 0.2 mEq/L; p = 0.6615) between the two groups. Conclusion: Isotonic solution administration enables avoidance of serum sodium reduction and serum glucose elevation in infants, and may therefore enhance patient safety in comparison with hypotonic solutions. Trial registration: University Hospital Medical Information Network Clinical Trials Registry ( UMIN000014648 ), registration 25 July 2014.

AB - Background: Reportedly, administration of hypotonic fluids containing 30.8-74 mEq/L sodium with 5 % glucose may lead to serious hyponatremia or hyperglycemia. In Japan, hypotonic fluids containing 90 mEq/L sodium with 2.6 % glucose are commonly used. We compared blood electrolyte balance and blood glucose concentration with the use of isotonic (140 mEq/L sodium with 1 % glucose) versus hypotonic fluids in pediatric patients. Methods: We studied 77 children aged 5 months to 2 years who underwent oro-maxillofacial surgery and dental treatment under general anesthesia. Patients were categorized according to the fluids infused (hypotonic or isotonic). Blood samples were obtained from the dorsalis pedis artery between the conclusion of anesthesia induction and commencement of surgery. We compared blood sodium, potassium and glucose concentrations in the two fluid groups during the pre-anesthesia and post-anesthesia-induction periods. Results: There were no significant differences in pre-anesthesia values between isotonic (n = 35) and hypotonic groups (n = 42). There were significant differences between isotonic and hypotonic groups in post-anesthesia-induction concentrations of sodium (isotonic, 138.7 ± 1.4 mEq/L; hypotonic, 137.5 ± 1.3 mEq/L; p = 0.0003) and glucose (isotonic, 88.0 ± 9.4 mg/dL; hypotonic, 109.9 ± 18.4 mg/dL; p < 0.0001), while potassium concentrations were not significantly different (isotonic, 4.0 ± 0.3 mEq/L; hypotonic, 4.0 ± 0.2 mEq/L; p = 0.6615) between the two groups. Conclusion: Isotonic solution administration enables avoidance of serum sodium reduction and serum glucose elevation in infants, and may therefore enhance patient safety in comparison with hypotonic solutions. Trial registration: University Hospital Medical Information Network Clinical Trials Registry ( UMIN000014648 ), registration 25 July 2014.

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