Fluid and electrolyte management

Fluid therapy is a core concept in the management of neurosurgical paediatric patients, aimed at correcting fl uid defi cit, maintaining intravascular volume, and providing tissues perfusion. Fluids should be considered like any other drug with indications, contraindications, and side eff ects. It is important to identify which compartment is depleted, since specifi c losses should be replaced with appropriate fl uids. Balanced crystalloids should be used for fl uid replacement, such as urinary output and insensible losses whereas colloids are indicated for volume replacement. Fluids that reduce osmolality should be avoided, especially in patients whose baseline osmolality has been increased by hyperosmolar fl uids. Dextrose should be used only in premature and small newborns to prevent hypoglycaemia. In the perioperative period, the patient is at risk of development of water and electrolytes disorders, mostly hyponatraemia (syndrome of inappropriate antidiuretic hormone secretion, cerebral salt-wasting syndrome) and hypernatraemia (diabetes insipidus), and a structured approach is required to provide appropriate diagnosis and treatment to avoid life-threatening or disabling electrolyte disturbances.