A randomised controlled trial of Hartmann's solution versus half normal saline in postoperative paediatric spinal instrumentation and craniotomy patients

Coulthard, Mark G., Long, Debbie A., Ullman, Amanda J. and Ware, Robert S. (2012) A randomised controlled trial of Hartmann's solution versus half normal saline in postoperative paediatric spinal instrumentation and craniotomy patients. Archives of Disease In Childhood, 97 6: 491-496. doi:10.1136/archdischild-2011-300221


Author Coulthard, Mark G.
Long, Debbie A.
Ullman, Amanda J.
Ware, Robert S.
Title A randomised controlled trial of Hartmann's solution versus half normal saline in postoperative paediatric spinal instrumentation and craniotomy patients
Journal name Archives of Disease In Childhood   Check publisher's open access policy
ISSN 0003-9888
1468-2044
Publication date 2012-06
Sub-type Article (original research)
DOI 10.1136/archdischild-2011-300221
Volume 97
Issue 6
Start page 491
End page 496
Total pages 6
Place of publication London, United Kingdom
Publisher B M J Group
Collection year 2013
Language eng
Formatted abstract
Objective:
To compare the difference in plasma sodium at 16-18 h following major surgery in children who were prescribed either Hartmann's and 5% dextrose or 0.45% saline and 5% dextrose.

Design:
A prospective, randomised, open label study.

Setting:

The paediatric intensive care unit (650 admissions per annum) in a tertiary children's hospital in Brisbane, Australia.

Patients:
The study group comprised 82 children undergoing spinal instrumentation, craniotomy for brain tumour resection, or cranial vault remodelling. Interventions: Patients received either Hartmann's and 5% dextrose at full maintenance rate or 0.45% saline and 5% dextrose at two-thirds maintenance rate.

Main outcomes measures:
Primary outcome measure: plasma sodium at 16-18 h postoperatively; secondary outcome measure: number of fluid boluses administered.

Results:
Mean postoperative plasma sodium levels of children receiving 0.45% saline and 5% dextrose were 1.4 mmol/l (95% CI 0.4 to 2.5) lower than those receiving Hartmann's and 5% dextrose (p=0.008). In the 0.45% saline group, seven patients (18%) became hyponatraemic (Na <135 mmol/l) at 16-18 h postoperatively; in the Hartmann's group no patient became hyponatraemic (p=0.01). No child in either fluid group became hypernatraemic.

Conclusions:
The postoperative fall in plasma sodium was smaller in children who received Hartmann's and 5% dextrose compared to those who received 0.45% saline and 5% dextrose. It is suggested that Hartmann's and 5% dextrose should be administered at full maintenance rate postoperatively to children who have undergone major surgery in preference to hypotonic fluids.
Keyword Hospital-acquired hyponatremia
Intravenous maintenance fluids
Antidiuretic-hormone
Inappropriate secretion
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published Online First 30 January 2012.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
School of Public Health Publications
School of Medicine Publications
 
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Created: Wed, 07 Mar 2012, 15:15:49 EST by Melanie Thomas on behalf of Paediatrics & Child Health - RBWH