Journal Article Comparison of the incidences of hyponatremia in adult postoperative critically ill patients receiving intravenous maintenance fluids with 140 mmol/L or 35 mmol/L of sodium: retrospective before/after observational study

Okada, Masako  ,  Egi, Moritoki  ,  Yokota, Yuri  ,  Shirakawa, Naotaka  ,  Fujimoto, Daichi  ,  Taguchi, Shinya  ,  Furushima, Nana  ,  Mizobuchi, Satoshi

31 ( 5 )  , pp.657 - 663 , 2017-10 , Springer
Purpose: Sodium-poor fluid, which is called hypotonic fluid, is currently recommended as intravenous maintenance fluid in critically ill adult patients. However, the use of such a hypotonic fluid may be associated with increased risk of hyponatremia. The purpose of this study was to compare the incidences of hyponatremia in adult postoperative critically ill patients receiving isotonic and hypotonic maintenance fluids. Methods: This study was a single-center retrospective before-after observational study. We included patients who had undergone an elective operation for esophageal cancer or for head and neck cancer and who received postoperative intensive care for more than 48 hours during the period from August 2014 to July 2016. In those patients, sodium-poor solution (35 mmol/L of sodium; Na35) had been administered as maintenance fluid until July 2015. From August 2015, the protocol for postoperative maintenance fluid was revised to the use of isotonic fluid (140 mmo/L of sodium; Na140). The primary outcome was the incidence of hyponatremia (< 135mmol/L) until the morning of postoperative day (POD) 2. Results: We included 179 patients (Na35 cohort: 87 patients, Na140 cohort: 92 patients) in the current study. The mean volume of fluid received from ICU admission to POD 2 was 3291 ml in the Na140 cohort, which was not significantly different from the mean volume of 3337 ml in the Na35 cohort (p=0.84). The incidence of postoperative hyponatremia was 16.3% (15/92) in the Na140 cohort, which was significantly lower than that of 52.9% (46/87) in the Na35 group (odds ratio=0.17 (95% confidence interval: 0.09-0.35), p<0.001). The incidences of hypernatremia, defined as serum sodium concentration >145 mmol/L, were not significantly different in the two groups. Conclusion: In this study, the use of intravenous maintenance fluid with 35 mmol/L of sodium was significantly associated with increased risk of hyponatremia compared to that with 140 mmol/L of sodium in adult postoperative critically ill patients.

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