A Prospective pilot study on perioperative fluid therapy in pediatric patients and its relationship with glucose homeostasis and ketosis.

Perioperative fluid management in paediatric surgical patients has beenthe focus for considerable interest and debate.The practice ofusing glucose containing hypotonic maintenance crystalloid solutions forperioperative fluid therapy is being questioned as there have been many casereports of serious morbidity or even death in previously healthy childrenassociated with the administration of i.v. fluids and hospital-acquiredhyponatraemia. Recent studies have shown that hypotonic solutions along withstress induced increased secretion of antidiuretic hormone (ADH)perioperatively can lead to hyponatraemic encephalopathy, permanentneurological damage and even death in children. Over the years there isincreasing evidence that blood sugars remain high despite using glucose freesolutions. The blood sugars may be normal due to endocrine or metabolic stress,so whether or not to use glucose containing fluids intraoperatively remains a controversy.Association of Paediatric Anaesthetists of Great Britain and Ireland consensus guidelinesand European consensus statement guidelines recommend intraoperative useof low dextrose (1–2.5%)containing isotonic fluids which have been shown tomaintain acceptable blood glucose levels and prevent electrolyte imbalancesduring surgery. It is not known whether such low glucose-containing fluidsmaintain blood glucose levels by initiating catabolism of the body’s own stores.The extent to which such a response can be limited by supplying additionalglucose without causing undue hyperglycaemia needs evaluation. If adequatecarbohydrates are not provided to fasting children it may lead to ketosis.  This study aims to observe relation betweenperioperative fluid therapy and its effects on glucose and lipid homeostasis.