Influence on Renal Function of Hypotonic Vs. Isotonic Saline Serum as Maintenance Therapy in Children during the Immediate Postoperative Period of General Surgery

Lopez-Castilla JD, Sanchez Valderrabanos E, Ortiz Alvarez A, Parrilla Parrilla J, Castro Gonzalez L, Murillo Pozo MA, Sanchez Ganfornina I, Vazquez Florido A, Charlo Molina MT, Cano Franco J and Moyano Leiva O

Published on: 2024-04-26

Abstract

Objective: To compare the risk of renal failure after general surgery in children, using hypotonic (HT) vs isotonic (IT) saline serum.

Study Design: Phase IV clinical trial, randomized 1/1. Age from 6 months to 14 years old, weight over 6 kg, creatinine at admission cut-off point of 0.5 mg/dL in children under 8 years old and 0.7 mg/dL in children over 8 years old. Variables: Age, weight, sex. Creatinine, urea, diuresis and urinary sodium concentration, in both study groups upon admission to PICU (Paediatric Intensive Care Unit), 8, 24 and 48 hours or transfer. Statistical significance level p<0.05.

Results: 124 selected patients, 59 HT serum (glucosaline 1/3:51 mEq/L of sodium) and 65 IT serum (glucosaline 5/0.9%:154 mEq/L of sodium). Age 64±50 months, mean weight 18.2 kg, 54% female, 47% male (p>0.05).

Plasma creatinine (mg/dL): admission 0.35±0.11HT, 0.37±0.10IT. 8 hours 0.34±0.12HT, 0.35±0.1IT. 24 hours 0.3±0,10HT, 0.30±0,1IT), 48 hours 0.3±0,11HT, 0.3±0,10IT, p>0, 05.

Plasma urea (mg/dL): admission 25±8HT, 27±8IT, 8 hours 22±16HT, 20±6IT, 24 hours 15±7 HT, 13±5IT, 48 hours 13±9HT, 14±7IT (p>0, 05).

Urinary sodium (mEq/L): admission 114±65HT, 128±62IT (p0.2), 8 hours 112±63HT, 173±74IT p0.001, 24 hours 86±70HT, 171±76IT, p0.001, 48 hours 59±41HT, 145±78IT (p0.001).

Diuresis (cc/kg/hour): admission 1,9±0,5HT, 2,3±0,6IT, 8 hours 2,6±1,5HT, 2,35±1,2IT, 24 hours 3±1,3HT, 4,03 ±2,4IT, 48 hours 2,84±1,1HT, 2,9±4 (p>0,05).

Conclusions: The use of isotonic saline serum compared to hypotonic saline serum produces an increase of sodium urinary excretion, but creatinine, urea and diuresis figures remain normal and do not alter other parameters of renal function during the first 48 hours after surgery.