Balanced electrolyte solution with 1% glucose as intraoperative maintenance fluid in infants: a prospective study of glucose, electrolyte, and acid-base homeostasis.

Abstract

Background: Optimal composition and infusion rates of intravenous maintenance fluids for children undergoing surgery are not well defined. Avoidance of hypoglycaemia, ketosis, and hyponatraemia is important, and current guidelines recommend isotonic fluids containing 1.0-2.5% glucose. However, evidence for its safe use in infants is insufficient. The aim of this study was to investigate whether normoglycaemia is maintained in infants using a balanced electrolyte maintenance infusion with 1% glucose.

Methods: Infants 1-12 months of age undergoing surgery were included in this prospective two-centre study. Intravenous maintenance fluid was given with infusion rates of 4-8 ml kg^-1 h^-1. Blood gas and ketone body analysis were performed at induction and at the end of anaesthesia. Plasma glucose concentration was monitored intraoperatively.

Results: For the 365 infants included in this study, the median infusion rate of maintenance fluid was 3.97 (interquartile range 3.21-5.35) ml kg^-1 h^-1. Mean plasma glucose concentration increased from 5.3 mM at induction to 6.1 mM at the end of anaesthesia (mean difference 0.8 mM; 95% confidence interval 0.6-0.9, P<0.001). No cases of hypoglycaemia (<3.0 mM) occurred. Mean sodium concentration remained stable during anaesthesia. Chloride and ketone body concentration increased and base excess decreased, but these were within the normal range.

Conclusions: In infants undergoing surgery, maintenance infusion with a balanced electrolyte solution containing 1% glucose, at rates similar to those proposed by Holliday and Segar is a safe alternative with regards to homeostasis of glucose, electrolytes, and acid-base balance.

Clinical trial registration: ACTRN12619000833167.