Boluses of Ringer's in Surgical Kids (BRiSK Study)

Recent studies have questioned the validity of each of these tenets. Maintenance rate as defined by Holliday & Segar is postulated to be in excess of pediatric patients' post-surgical fluid needs. The investigators propose a novel protocol for the administration of IV fluids to children after major abdominal or thoracic surgery that includes: (1) Intermittent boluses; (2) Total volume administered in 24 hours closer to 2/3 of the traditional maintenance fluid requirements; and (3) Use of a balanced salt solution (Lactated Ringer).

Inclusion criteria

• Males or females age 12 months to 21 years.
• Weight >= 8 kg.
• Patients with an uncomplicated abdominal or thoracic surgical procedure in which the expected postoperative length of stay is anticipated to be at least 2-5 days.
• Patients admitted to a regular bed following surgery.
• Patients who will be inpatient for approximately 4-8 days postoperatively.
• Parental/guardian permission (informed consent).

Exclusion criteria

• Patients with a history of diabetes, seizures, hyperglycemia, and hypoglycemia.
• Patients prescribed insulin.
• Patients receiving parenteral nutrition.
• Patients with excessive GI losses (small bowel obstruction, severe diarrhea, large-volume ascites or drainage).
• Complicated surgery that requires an ICU or ICU transfer immediately after surgery.
• Patients with any form of hypersensitivity to the study fluids.
• Laboratory abnormalities that indicate clinically significant hematologic, hepatobiliary, or renal disease:

• Serum Sodium <130 or >145 mmol/L
• Serum Potassium <3.0 or >5.0 mEq/L
• Serum Chloride <90 or >110 mEq/L
• Serum Creatinine ≥ 1.6 mg/dL
• Serum Glucose <60 or >180 mg/dL
• Alanine Aminotransferase >200 U/L
• Total Bilirubin >12.0 mg/dL
• Pregnant or lactating females.
• Parents/guardians or subjects who, in the opinion of the Investigator, may be non-compliant with study schedules or procedures.