Hiponatrémia nas Primeiras 24 Horas Pós-cirurgia Otorrinolaringológica Minor Secundária ao Uso de Lactato de Ringer

 

Ana Alegria*, Maria Paz Alonso*, Sandra Guimarães*, Ana Paula Alves*, Maria José Nunes*, Maria Filomena Caldas*, Inês Sousa†

*Serviço de Anestesiologia, Hospital Especializado para Crianças Maria Pia, Porto;

†Department of Medicine, Lancaster University, UK

 

Introdução: A água e os iões são provavelmente os agentes farmacológicos mais prescritos nos doentes hospitalizados. A hiponatrémia, definida como sódio plasmático < 136 mmol/L, é a alteração electrolítica mais comum do uso de fluidos hipotónicos em crianças.

Métodos: Setenta crianças submetidas a cirurgia otorrinolaringológica minor sob anestesia geral. O Lactato de Ringer foi o soro usado para suprir as necessidades de fluidos no período pós-operatório. A fluidoterapia endovenosa foi suspensa às 6 horas do pós-operatório, iniciando-se a alimentação oral. Para modelar a resposta sódio, foi usado um modelo linear geral para dados longitudinais com efeitos aleatórios ao nível de indivíduos.

Resultados: A razão pela qual o sódio se altera nas primeiras seis horas pós-operatórias é de -0,116 mmol/L por hora e esta é significativa (p=0,041). Se a fluidoterapia endovenosa fosse mantida por mais de seis horas, suspeita-se que valores de hiponatrémia fossem alcançados em 20 horas pós-cirurgia.

Conclusões: Soros isotónicos podem também levar a hiponatrémias. A prescrição de fluidoterapia endovenosa deve ser individualizada. A monitorização e avaliação cuidada com medição do peso diário, balanços hídricos, tensões arteriais, sinais de edema e sódio plasmático são fundamentais. Não existe consenso sobre qual é o melhor soro e a quantidade ideal para prevenir a hiponatrémia relacionada com a fuidoterapia de manutenção nas crianças hospitalizadas.

Palavras-chave: hiponatrémia; fluidoterapia; endovenosa; crianças; hormona anti-diurética.

 

Hyponatremia during the first 24 hours following minor ear, nose and throat surgery secondary to the use of ringer lactate solution

Introduction: Salt and water are probably the commonest therapeutic agents given to hospitalized patients. Hyponatremia is defined as a plasma sodium concentration (PNa)< 136 mmol/l and has been recognized, in the last decades, as the most commonelectrolyte disturbance related to hypotonic fluids received by children.

Methods: 70 children who had ear, nose and throat (ENT) surgery under general anesthes were studied. Ringer Lactate was used for fluid requirement during the peri-operative period. Fluid therapy was suspended 6 hours after surgery, and oral fluids and feeding were started. A general linear model for longitudinal data was used.

Results: The mean change in sodium concentration in the first 6 hours after surgery was -0.116 mmol/L per hour and is significant (p=0.041). If parenteral fluid therapy had continued longer, there is evidence that hyponatremia would develop at approximately 20 hours postoperatively.

Conclusion: Children receiving isotonic fluids are at risk of hyponatremia. Intravenous fluid therapy should be individualized. Proper care and evaluation with daily weighing, checking for signs of edema, monitoring intake/output and vital signs, and regular checks of plasma sodium concentration are fundamental. There is no agreement about which fluid is better and how much fluid is ideal to prevent hospital-acquired hyponatremia in children.

Key-words: hyponatremia; fluid therapy; intravenous; children; antidiuretic hormone.

 

 

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Correspondência:

Dr.ª Ana Alegria

Serviço de Anestesiologia Hospital Especializado para Crianças

Maria Pia

Rua da Boavista, 827

4050-111 Porto

e-mail: afgalegria@hotmail.com