La déshydratation hypernatrémique chez l'enfant : étude rétrospective de 105 cas

Abstract

The hypernatremic dehydration defined by a serum sodium concentration > to 150 mmol/l, is a particular form of acute dehydration and constitutes a medical emergency requiring a prompt and adequate diagnosis and management. Purpose. – To precise the epidemiological profile, course, causes and therapeutic particularities of hypernatremic dehydration in children. Population and methods. – Retrospective review of 105 children admitted in the general Paediatrics department of the Fattouma Bourguiba university hospital in Monastir (Tunisia), for hypernatremic dehydration between January 1st 1990 and December 31 2002. Results. – Hypernatremic dehydration represented 11,51% of all kinds of dehydration. The mean age was 6.5 months with a small male predominance. The socio-economic level of the parents was good in 62.8% of cases. Half of the children were in shock. Severe dehydration was present in 87.6% of cases and neurological signs were observed in 77.14% of cases. The initial mean serum sodium concentration was 159 mmol/L. Acidosis and acute renal failure were associated respectively in 97.2% and 76.2% of cases. Prominent cause of hypernatremic dehydration was diarrhoea (94.3%). Intravenous rehydration with 5% glucose solution at the average of 147 ml/kg/day and containing a mean sodium level of 42 mmol/L was performed in 74% of cases. In most cases (84.1%) serum sodium was normalized within the first 72 hours. Complications were noted in 5.7% of cases and mortality rate was 11.4%. Conclusion. – Hypernatremic dehydration was common in infant and the prominent cause is still dominated by diarrhoea in our country. The management of hypernatremic dehydration is based on oral or intravenous rehydration and plasma expanding fluids when shock is present or imminent. The serum sodium concentration should be gradually corrected and should not exceed 0,5 mmol/L/h. Prevention is based on the pursuit of breastfeeding and the use of oral rehydration solution in infantile diarrhoeas.