None listed
Conditions
Brief summary
There is a prevalent view that in hospitalized patients with high circulating plasma vasopressin levels the administration of hypotonic fluid therapy is invariably associated with the occurrence of hyponatremia. Consequently, the prescription of hypotonic fluid therapy to hospitalized patients is discouraged. In a previous study, conducted in children admitted with acute appendicitis, we have observed that correction of hypovolemia with near-isotonic fluid solution followed by hypotonic maintenance intravenous fluid therapy was not consistently associated with post-operative hyponatremia, and that the degree of hyponatremia in patients that became hyponatremic was always mild (Lindestam U. et al. Ped. Res. 2019). We noted that in patients with high circulating vasopressin levels, the degree of post-operative water retention declined significantly, as patients became euvolemic. This apparent escape from the antidiuretic effects of vasopressin attracted our attention and therefore is the focus of the proposed investigation. Our assumption is that on admission most participants will have high circulating vasopressin levels. As a result of fluid therapy, we expect therefore a decrease of plasma-sodium at the end of surgery. The collection of new data has been planned based on an existing hypothesis, namely that we anticipate that some participants will show an escape from the antidiuretic effects of vasopressin. To shed light on this phenomenon, we will evaluate the changes in plasma-sodium from hospital admission to the end of surgery in acutely ill normonatremic children with appendicitis and relate them to key hormones involved in sodium and water homeostasis, to how much free water is being excreted or reabsorbed, and to surrogate markers of vasopressin-dependent trafficking of aquaporin-2 water channel.
Interventions
This cohort study that will be conducted in normonatremic children admitted with acute appendicitis. On admission, all patients will receive an intravenous infusion of 50 mL/kg of Ringer’s acetate solution (131 mmol/L sodium, 4 mmol/L potassium, 2 mmol/L magnesium, 110 mmol/L chloride, 30 mmol/L acetate; Fresenius Kabi®) over four hours. This infusion will be followed by a maintenance fluid and electrolyte therapy phase consisting of a hypotonic 0.46% normal sodium chloride (80 mmol/L sodium, 20
This cohort study that will be conducted in normonatremic children admitted with acute appendicitis. On admission, all patients will receive an intravenous infusion of 50 mL/kg of Ringer’s acetate solution (131 mmol/L sodium, 4 mmol/L potassium, 2 mmol/L magnesium, 110 mmol/L chloride, 30 mmol/L acetate; Fresenius Kabi®) over four hours. This infusion will be followed by a maintenance fluid and electrolyte therapy phase consisting of a hypotonic 0.46% normal sodium chloride (80 mmol/L sodium, 20 mmol/L potassium, 100 mmol/L chloride; extempore solution) in 5% glucose solution until the start of the surgery. At the maintenance stage, infusion rate will be decreased to 80% of normal maintenance fluid therapy. The duration of the maintenance fluid phase will be approximately 12 hours. All participants will normally receive this treatment regardless of their involvement in this observational study. During surgery, fluids will be administered at anesthetist’s discretion. The total duartion of the observation for participants in this sudy will be until the end of surgery.
Sponsors
Rafael Tomas Krmar
Eligibility
Sex/Gender
All
Age
10 Years to 18 Years
Healthy volunteers
No
Inclusion criteria
1). Admitted for suspected appendicitis. 2). Informed consent obtained from parents and if applicable from the child.
Exclusion criteria
1). Having received intravenous fluid therapy before the admission at our hospital 2). Plasma-sodium <135 mmol/L. 3). Documented diagnosis of renal, endocrine, or metabolic disease.
Outcome results
None listed