{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:08:53Z","timestamp":1771459733312,"version":"3.50.1"},"reference-count":24,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Perioperative fluid management is an important component of enhanced recovery pathways for microsurgical breast reconstruction. Historically, fluid management has been liberal. Little attention has been paid to the biochemical effects of different protocols. This study aims to reduce the risk of postoperative hyponatremia by introducing a new fluid management protocol.<\/jats:p><jats:p>\n          Methods\u2003A single-institution cohort study comparing a prospective series of patients was managed using a new \u201cmodestly restrictive\u201d fluid postoperative fluid management protocol to a control group managed with a \u201cliberal\u201d fluid management protocol.<\/jats:p><jats:p>\n          Results\u2003One-hundred thirty patients undergoing microsurgical breast reconstruction, at a single institution during 2021, are reported. Hyponatremia is demonstrated to be a significant risk with the original liberal fluid management protocol. At the end of the first postoperative day, mean fluid balance was +2,838\u2009mL (\u00b1 1,630\u2009mL). Twenty-four patients of sixty-five (36%) patients had low blood sodium level, 14% classified as moderate-to-severe hyponatremia. Introducing a new, \u201cmodestly-restrictive\u201d protocol reduced mean fluid balance on day 1 to +844\u2009mL (\u00b1700) (p \u2264 0.0001). Incidence of hyponatremia reduced from 36 to 14% (p\u2009=\u20090.0005). No episodes of moderate or severe hyponatremia were detected. Fluid intake, predominantly oral water, between 8am and 8pm on the first postoperative day is identified as the main risk factor for developing hyponatremia (odds ratio [OR]: 7; p\u2009=\u20090.019). Modest fluid restriction, as guided by the new protocol, protects patients from low sodium level (OR: 0.25; confidence interval: 95%; 0.11\u20131.61; p\u2009=\u20090.0014).<\/jats:p><jats:p>\n          Conclusion\u2003The original \u201cliberal\u201d fluid management protocol encouraged unrestricted postoperative oral intake of water. Patients were often advised to consume in excess of 5\u2009L in the first 24\u2009hours. This unintentionally, but frequently, was associated with moderate-to-severe hyponatremia. We present a new protocol characterized by early cessation of intravenous fluid and an oral fluid limit of 2,100\u2009mL\/day associated with a significant reduction in the incidence of hyponatremia and fluid overload.<\/jats:p>","DOI":"10.1055\/a-1939-5874","type":"journal-article","created":{"date-parts":[[2022,9,8]],"date-time":"2022-09-08T23:18:22Z","timestamp":1662679102000},"page":"035-042","source":"Crossref","is-referenced-by-count":3,"title":["Hyponatremia after Autologous Breast Reconstruction: A Cohort Study Comparing Two Fluid Management Protocols"],"prefix":"10.1055","volume":"39","author":[{"given":"Francesca","family":"Ruccia","sequence":"first","affiliation":[{"name":"Department of Plastic Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica Anne","family":"Savage","sequence":"first","affiliation":[{"name":"Plastic and Reconstructive Surgery Department, Salisbury District Hospital, Salisbury, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Parviz","family":"Sorooshian","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Lees","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Critical care, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vasiliki","family":"Fesatidou","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Zoccali","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Queen Victoria 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