• Mark G Coulthard, Debbie A Long, Amanda J Ullman, and Robert S Ware.
• Academic Discipline of Paediatrics and Child Health, University of Queensland, Herston, QLD 4029, Australia. Mark_Coulthard@health.qld.gov.au
• Arch. Dis. Child. 2012 Jun 1;97(6):491-6.

ObjectiveTo 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.DesignA prospective, randomised, open label study.SettingThe paediatric intensive care unit (650 admissions per annum) in a tertiary children's hospital in Brisbane, Australia.PatientsThe study group comprised 82 children undergoing spinal instrumentation, craniotomy for brain tumour resection, or cranial vault remodelling.InterventionsPatients 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 MeasuresPrimary Outcome Measureplasma sodium at 16-18 h postoperatively; secondary outcome measure: number of fluid boluses administered.ResultsMean 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.ConclusionsThe 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.

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