 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
1 January 1997 | Volume 126 Issue 1 | Pages 20-25
Background: It is widely presumed that the development of postoperative hyponatremia (which may be severe) results from administration of hypotonic fluids while antidiuretic hormone is acting.
Objective: To show that hyponatremia would occur in patients 24 hours after surgery if only near-isotonic solutions are given and to evaluate the mechanisms responsible for hyponatremia in this setting.
Design: Prospective cohort study.
Setting: University medical center.
Patients: 22 women who were having uncomplicated gynecologic surgery with infusion of near-isotonic solutions only (sodium chloride, 154 mmol/L, or Ringer lactate [sodium, 130 mmol/L, and potassium, 4 mmol/L]).
Measurements: Plasma electrolyte levels were measured at the time of induction of anesthesia and 24 hours later. Data on the balance of water and electrolytes were obtained for the same 24-hour period.
Results: At the time of induction of anesthesia, the plasma sodium concentration was 140 ± 1 mmol/L; 24 hours later, it decreased in 21 of 22 patients (mean decrease, 4.2 ± 0.4 mmol/L [P < 0.001]; lowest level, 131 mmol/L in 2 patients). The urine remained hypertonic (peak sodium plus potassium concentration in urine, 294 ± 9 mmol/L) in all patients for the first 16 hours after induction of anesthesia.
Conclusions: Postoperative hyponatremia occurred within 24 hours of induction of anesthesia when only near-isotonic fluids were infused. Hyponatremia was generally caused by generation of electrolyte-free water during excretion of hypertonic urine-a desalination process. This electrolyte-free water was retained in the body because of the actions of antidiuretic hormone. If the pathophysiology of this hyponatremic state is understood, recommendations for its prevention and treatment can be deduced.
Author and Article Information
From St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
ARTICLE
Postoperative Hyponatremia despite Near-Isotonic Saline Infusion: A Phenomenon of Desalination
Requests for Reprints: Mitchell L. Halperin, MD, St. Michael's Hospital, Lab #1, Research Wing, 38 Shuter Street, Toronto, Ontario M5B 1A6, Canada.
Current Author Addresses: Drs. Steele, Gowrishankar, Abrahamson, Mazer, and Halperin: St. Michael's Hospital, 38 Shuter Street, Toronto, Ontario M5B 1A6, Canada.
This article has been cited by other articles:
|
|
 |
|
  R. H. Sterns and S. M. Silver Cerebral Salt Wasting Versus SIADH: What Difference? J. Am. Soc. Nephrol., February 1, 2008; 19(2): 194 - 196. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. E. Beck Hypotonic Versus Isotonic Maintenance Intravenous Fluid Therapy in Hospitalized Children: A Systematic Review Clinical Pediatrics, December 1, 2007; 46(9): 764 - 770. [Abstract] [PDF]
|
|
|
|
 |
|
 A.P.C.P. Carlotti, D. Bohn, N. Jankiewicz, K.S. Kamel, M.R. Davids, and M.L. Halperin A hyperglycaemic hyperosmolar state in a young child: diagnostic insights from a quantitative analysis QJM, February 1, 2007; 100(2): 125 - 137. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K Choong, M E Kho, K Menon, and D Bohn Hypotonic versus isotonic saline in hospitalised children: a systematic review Arch. Dis. Child., October 1, 2006; 91(10): 828 - 835. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Cunliffe and F. Potter Four and a fifth and all that. Br. J. Anaesth., September 1, 2006; 97(3): 274 - 277. [Full Text] [PDF]
|
|
|
|
|
|
C. Way, R. Dhamrait, A. Wade, and I. Walker Perioperative fluid therapy in children: a survey of current prescribing practice Br. J. Anaesth., September 1, 2006; 97(3): 371 - 379. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. G. Narins, Participants:, M. Halperin, G. Danovitch, R. Falk, and J. Bargman The Nephrology Quiz and Questionnaire: 2005 Clin. J. Am. Soc. Nephrol., May 1, 2006; 1(3): 592 - 608. [Full Text] [PDF]
|
|
|
|
|
|
K A Neville, C F Verge, A R Rosenberg, M W O'Meara, and J L Walker Isotonic is better than hypotonic saline for intravenous rehydration of children with gastroenteritis: a prospective randomised study Arch. Dis. Child., March 1, 2006; 91(3): 226 - 232. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. A. Neville, C. F. Verge, M. W. O'Meara, and J. L. Walker High Antidiuretic Hormone Levels and Hyponatremia in Children With Gastroenteritis Pediatrics, December 1, 2005; 116(6): 1401 - 1407. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Bohn, M.R. Davids, O. Friedman, and M.L. Halperin Acute and fatal hyponatraemia after resection of a craniopharyngioma: a preventable tragedy QJM, September 1, 2005; 98(9): 691 - 703. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. J. Hoorn, M. L. Halperin, and D. Bohn Isotonic Saline Expands Extracellular Fluid and Is Inappropriate for Maintenance Therapy: In Reply Pediatrics, January 1, 2005; 115(1): 194 - 194. [Full Text] [PDF]
|
|
|
|
|
|
M. Hatherill, Z. Waggie, S. Salie, and A. Argent Hospital-Acquired Hyponatremia Is Associated With Excessive Administration of Intravenous Maintenance Fluid Pediatrics, November 1, 2004; 114(5): 1368 - 1368. [Full Text] [PDF]
|
|
|
|
|
|
M Hatherill Rubbing salt in the wound Arch. Dis. Child., May 1, 2004; 89(5): 414 - 418. [Full Text] [PDF]
|
|
|
|
|
|
E. J. Hoorn, D. Geary, M. Robb, M. L. Halperin, and D. Bohn Acute Hyponatremia Related to Intravenous Fluid Administration in Hospitalized Children: An Observational Study Pediatrics, May 1, 2004; 113(5): 1279 - 1284. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. L. Moritz and J. C. Ayus The pathophysiology and treatment of hyponatraemic encephalopathy: an update Nephrol. Dial. Transplant., December 1, 2003; 18(12): 2486 - 2491. [Full Text] [PDF]
|
|
|
|
|
|
M.A.S. Shafiee, D. Bohn, E.J. Hoorn, and M.L Halperin How to select optimal maintenance intravenous fluid therapy QJM, August 1, 2003; 96(8): 601 - 610. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.R. Davids, S.-H. Lin, Y. Edoute, S. Cheema-Dhadli, and M.L. Halperin Hyponatraemia and hyperglycaemia during laproscopic surgery QJM, May 1, 2002; 95(5): 321 - 330. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Bohn Children are another group at risk of hyponatraemia perioperatively BMJ, November 6, 1999; 319(7219): 1269 - 1269. [Full Text]
|
|
|
|
 |
|
 J. C. Ayus and A. I. Arieff Chronic Hyponatremic Encephalopathy in Postmenopausal Women: Association of Therapies With Morbidity and Mortality JAMA, June 23, 1999; 281(24): 2299 - 2304. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. F. Husted, C. Zhang, and J. B. Stokes Concerted actions of IL-1beta inhibit Na+ absorption and stimulate anion secretion by IMCD cells Am J Physiol Renal Physiol, December 1, 1998; 275(6): F946 - F954. [Abstract] [Full Text] [PDF]
|
|
Article
