Perioperative fluid-, sodium-, and glucose balance in children | Acute kidney injury in critically ill children

Hyponatremia as well as hypo-and hypoglycemia are associated with increased morbidity and mortality in the perioperative period. Children are more susceptible as compared to adults. Our research, led by Urban Fläring, have conducted studies that showed high incidence of hyponatremia and hyperglycemia using former guidelines. Our findings have resulted in new clinical routines.

Currently, we are focusing upon infants to investigate if near-isotonic in 1 % glucose is the ideal intraoperative maintenance fluid avoiding both iatrogenic sodium- and glucose imbalances. In parallel, the glucose production rate and energy expenditure are characterized.

We have shown that the mortality during intensive care is low in children as compared to adults but increases substantially if multiple organ failure and acute kidney injury (AKI) ensues. AKI is often combined with fluid overload. In the most severe cases, continuous renal replacement (CRRT) is needed. CRRT and complication is well investigated in children.

We are currently characterizing CRRT-associated thrombotic complications. In addition, conduct a follow-up study, investigating the incidence of chronic renal failure. Finding children with impaired renal function at an early stage after severe AKI may enable medical treatment that can make requirement of chronic dialysis and/or transplantation unnecessary or at least postpone.

Group members

Urban Fläring

Associate Professor, Group leader

Åke Norberg

Associate professor, co-supervisor

Olav Rooijackers

Professor, co-supervisor

Per-Arne Lönnqvist

Professor, co-supervisor

Ulf Lindestam

Doctoral student

Isabelle Szeps

Doctoral student


  • Njurfonden
  • Läkarsällskapet
  • Sällskapet Barnavård

Selected publications

Low Plasma Sodium Concentration Predicts Perforated Acute Appendicitis in Children: A Prospective Diagnostic Accuracy Study.
Lindestam U, Almström M, Jacks J, Malmquist P, Lönnqvist PA, Jensen BL, Carlström M, Krmar RT, Svensson JF, Norberg Å, Fläring U
Eur J Pediatr Surg 2020 Aug;30(4):350-356

Short- and Long-Term Outcome in Critically Ill Children After Acute Interhospital Transport to a PICU in Sweden.
Hannegård Hamrin T, Radell PJ, Fläring U, Berner J, Eksborg S
Pediatr Crit Care Med 2020 07;21(7):e414-e425

Serum selenium in critically ill patients: Profile and supplementation in a depleted region.
Broman LM, Bernardson A, Bursell K, Wernerman J, Fläring U, Tjäder I
Acta Anaesthesiol Scand 2020 07;64(6):803-809

Incidence of and risk factors for venous thrombosis in children with percutaneous non-tunnelled central venous catheters.
Östlund Å, Fläring U, Norberg Å, Dahlberg A, Berner J, Kaiser S, Vermin L, Svenningsson A, Frisk T, Larsson P, Andersson A
Br J Anaesth 2019 Sep;123(3):316-324

Fluid balance after continuous renal replacement therapy initiation and outcome in paediatric multiple organ failure.
Andersson A, Norberg Å, Broman LM, Mårtensson J, Fläring U
Acta Anaesthesiol Scand 2019 09;63(8):1028-1036

Sodium and water homeostasis in children admitted with acute appendicitis: a prospective study.
Lindestam U, Fläring U, Almström M, Andersson A, Svensson JF, Malmquist P, Jacks J, Lönnqvist PA, Jensen BL, Carlström M, Krmar RT
Pediatr Res 2019 07;86(1):5-8

Low serum selenium is associated with the severity of organ failure in critically ill children.
Broman M, Lindfors M, Norberg Å, Hebert C, Rooyackers O, Wernerman J, Fläring U
Clin Nutr 2018 08;37(4):1399-1405

Whole blood glutathione status and ICU morbidity in critically ill children.
Fläring U, Ekmark L, Wernerman J, Rooyackers O
Acta Anaesthesiol Scand 2015 Nov;59(10):1311-8

Plasma glutamine deficiency is associated with multiple organ failure in critically ill children.
Ekmark L, Rooyackers O, Wernerman J, Fläring U
Amino Acids 2015 Mar;47(3):535-42

The efficacy of hypotonic and near-isotonic saline for parenteral fluid therapy given at low maintenance rate in preventing significant change in plasma sodium in post-operative pediatric patients: protocol for a prospective randomized non-blinded study.
Fläring U, Lönnqvist PA, Frenckner B, Svensson JF, Ingolfsson I, Wallensteen L, Stigzelius S, Kowalski J, Krmar RT
BMC Pediatr 2011 Jul;11():61


Urban Fläring

Affiliated to research