Inappropriate secretion of antidiuretic hormone in postoperative scoliosis patients - The role of fluid management

Study Design, The present study examined the hypothesis that hypotonic saline therapy before surgery was a major factor in the development of the syndrome of inappropriate antidiuretic hormone secretion. Objectives, The influence of fluid therapy and its relationship to the syndrome of inappropriate antidiuretic hormone secretion was studied by measuring patient electrolyte and osmolar responses at given times after surgery. Summary of Background Data, Mild renal dysfunction and increased plasma antidiuretic hormone occurs after surgery. Occurrence of the syndrome of inappropriate secretion of antidiuretic hormone after spine surgery is rare. The development of the syndrome of inappropriate secretion hormone after surgery may be related to hypotonic fluid replacement during and after surgery. Methods, Twelve patients undergoing surgery for correction of idiopathic scoliosis were assigned randomly to two groups. The control group (five patients) was given isotonic saline, and the trial group (seven patients) was given hypotonic saline. Results, The trial group developed syndrome of inappropriate antidiuretic hormone secretion with a significant decrease in serum sodium and osmolarity. The control group did not develop syndrome of inappropriate antidiuretic hormone secretion. Conclusions, Hypotonic saline therapy predisposes to the development of syndrome of inappropriate antidiuretic hormone secretion, whereas isotonic saline protects patients from syndrome of inappropriate antidiuretic hormone secretion when undergoing surgery for scoliosis.