Hyponatremia in infants with community-acquired infections on hospital admission.

Marta B Mazzoni,Carlo Agostoni,Gregorio P Milani,Alessia Rocchi,Emilio F Fossali,Emanuela A D’Angelo,Marco Alberzoni,Silvia Bernardi,Mario G Bianchetti,Ludovica Odone,Adriana Calderaro

doi:10.1371/journal.pone.0219299

Abstract

Acute moderate to severe gastroenteritis is traditionally associated with hypernatremia but recent observations suggest that hypernatremia is currently less common than hyponatremia. The latter has sometimes been documented also in children with acute community-acquired diseases, such as bronchiolitis and pyelonephritis. We investigated the prevalence of dysnatremia in children with acute moderate severe gastroenteritis, bronchiolitis and pyelonephritis. This prospective observational study included 400 consecutive previously healthy infants ≥4 weeks to ≤24 months of age (232 males and 168 females): 160 with gastroenteritis and relevant dehydration, 160 with moderate-severe bronchiolitis and 80 with pyelonephritis admitted to our emergency department between 2009 and 2017. Circulating sodium was determined by means of direct potentiometry. For analysis, the Kruskal-Wallis test and the Fisher’s exact test were used. Hyponatremia was found in 214 of the 400 patients. It was common in gastroenteritis (43%) and significantly more frequent in bronchiolitis (57%) and pyelonephritis (68%). Patients with hyponatremia were significantly younger than those without hyponatremia (3.9 [1.6–13] versus 7.5 [3.4–14] months). The gender ratio was similar in children with and without hyponatremia. Hyponatremia was associated with further metabolic abnormalities (hypokalemia, hyperkalemia, metabolic acidosis or metabolic alkalosis) in gastroenteritis (71%) and pyelonephritis (54%), and always isolated in bronchiolitis. In conclusion, hyponatremia is common at presentation among previously healthy infants with gastroenteritis, bronchiolitis or pyelonephritis. These data have relevant consequences for the nutrition and rehydration management in these conditions.

Highlights

Acute gastroenteritis with relevant dehydration is traditionally associated with hypernatremia [1,2,3]
Two preliminary reports from our institution documented that hyponatremia is very frequent on admission among otherwise healthy infants affected by moderate-severe bronchiolitis or pyelonephritis [6, 7]
The age was on the average higher in the group with gastroenteritis compared to bronchiolitis or pyelonephritis and in pyelonephritis compared to bronchiolitis

Summary

Introduction

Acute gastroenteritis with relevant dehydration is traditionally associated with hypernatremia [1,2,3]. Some observations suggest that hypernatremia is currently less common than hyponatremia [1,2,3]. The latter electrolyte abnormality has sometimes been documented . Two preliminary reports from our institution documented that hyponatremia is very frequent on admission among otherwise healthy infants affected by moderate-severe bronchiolitis or pyelonephritis [6, 7]. The aim of the present study is to compare sodium, potassium and acid-base balance in the aforementioned infants with bronchiolitis or pyelonephritis and in infants with gastroenteritis

Objectives

Methods

Results

Conclusion