Hypotonic Versus Isotonic Parenteral (HIP) Fluid Trial
Condition: Hyponatremia; Hypernatremia
MeSH terms: Hyponatremia; Hypernatremia
Intervention: 0.9% NaCl; 0.45%NaCl
Intervention description: Intravenous Fluid
Isotonic Parenteral Fluid; Intravenous Fluid
Hypotonic Parenteral Fluid
Phase: Phase 3
Study type: Interventional
Primary purpose: Prevention
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Enrollment: 258.0
Sex: All
Minimum age: 6 Months
Maximum age: 16 Years
Healthy volunteers: Accepts Healthy Volunteers
Keywords: Parenteral Fluids; Isotonic; Hypotonic; Pediatric; Fluid overload

Summary:

      Children who are undergoing surgery need intravenous fluids to prevent dehydration and
      maintain their electrolyte balance. The current standard of care in these children is to use
      a fluid which is low in sodium (hypotonic fluid). The safety of this practice has never been
      tested. There is ongoing concern from the medical community that this type of fluid increases
      the child's risk of developing low sodium levels, and hence may not be safe for all children.
      Low sodium can lead to significant complications such as seizures, coma and even death, risks
      of which are often underestimated and not anticipated by their caregivers. Experts in the
      field suggest that giving a solution with a similar sodium content to that of blood (isotonic
      fluid) reduces the risk of these problems in these children. This study will compare these
      two types of intravenous fluids (hypotonic versus isotonic), in a blinded fashion (i.e.
      neither the patient nor caregivers or investigators will be aware which type of fluid the
      patient is receiving), in children following surgery. The investigators goal is to see which
      type of fluid is safer, and leads to more stable sodium levels. This would in turn lead to a
      lower risk of complications as described above.

      This is the first time such a study is preformed in pediatrics. There are unnecessary number
      of complications and potential deaths from this disorder, and hence the safety of everyday
      fluid practice in children needs to be scientifically tested. The results of this study will
      enable the investigators to propose scientifically based guidelines on how to minimize risks
      associated with intravenous infusions in children.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Pediatric patients, 6 months corrected age -16 years, undergoing surgery.

          -  Within 6 hours of the immediate post-operative period.

          -  Post-operative stay anticipated to be more than 24 hours.

          -  Primary route of fluid administration is anticipated to be intravenous, in the first
             24 hours following surgery.

          -  Informed consent of parent/guardian.

          -  Consent to participate from surgeon.

        Exclusion Criteria:

          -  Patients under 6 months of age

          -  Patients equal to or over 17 years of age

          -  Patients with hemodynamic instability , defined as a requirement for continuous
             vasoactive infusion (e.g. epinephrine, dopamine, norepinephrine, phenylephrine,
             milrinone, or Dobutamine) to maintain blood pressure at the end of surgery.

          -  Patients admitted into the "short stay" post-operative unit

          -  Patients in whom either hypotonic or isotonic solutions may be
             contraindicated/necessary: i.e. specific neurosurgical patients (ie those at risk of
             increased ICP, e.g. requiring actual brain surgery, ICP monitor or external
             ventricular drain insertion), patients with diabetic ketoacidosis, acute (≤ 7 days)
             burns, pre-existing CHF, liver failure or cirrhosis, renal failure.

          -  Patients with known pre-existing risk of PNa derangements: DI or SIADH

          -  Chronic diuretic use - defined as use of any oral or intravenous diuretics for ≥ 7
             days.

          -  Known, uncorrected PNa derangement (PNa < 134 or > 146 mmol/L), identified
             peri-operatively (i.e. within 12 hours of surgery or during surgery).

          -  Prior enrolment in this study

          -  Patients or their guardians objecting to give consent.