Use of low-glucose isotonic solutions intraoperatively in infants: reassuring data regarding the risk of intraoperative hypoglycaemia

Abstract

In years past, it was standard of practice to use high-glucose, low-sodium i.v. infusions as maintenance fluids intraoperatively. However, this tradition was associated with the risk of developing severe postoperative hyponatraemia, which sometimes resulted in cerebral oedema and even death. Research, information, consensus guidelines, and lobbying the pharma industry to produce a low-glucose isotonic solution that would be optimised for use in children has now resulted in a much needed change of practice. However, an outstanding issue has been whether 1% glucose in i.v. solutions is enough or too little to safeguard against intraoperative hypoglycaemia in infants. Lindestam and colleagues have now reported results from a relatively large prospective observational study (n=365) that use of a 1% glucose isotonic solution at normal maintenance rates resulted in a zero incidence of hypoglycaemia (defined as glucose <3 mM) with maintained sodium homeostasis. A major issue in the context of intraoperative maintenance fluids in children has now been answered.

Keywords: fluid management; glucose; hypoglycaemia; infants; sodium.