Prevention of Hospital-Acquired Hyponatremia: Do We Have the Answers?

Abstract

Hyponatremia (serum sodium < 135 mEq/L) is the most frequently occurring electrolyte abnormality in children and affects ∼25% of hospitalized patients.1,2 The majority of the hyponatremia seen in children is hospital acquired3 and occurs in children who are receiving hypotonic intravenous fluids.4 A serious complication of hyponatremia is acute hyponatremic encephalopathy, for which children are at particularly high risk because of their larger brain/intracranial-volume ratio.5 There have been numerous reports of death and permanent neurologic injury from hospital-acquired hyponatremia, all of which have been associated with administration of hypotonic fluids.5,–,7 These deaths have drawn the attention of the National Patient Safety Agency in the United Kingdom8 and the Institute for Safe Medication Practices of Canada9 and the United States,10 which have issued warnings about the dangers of administering hypotonic fluids. For more than 50 years the standard of care for maintenance fluid therapy in children has been to administer hypotonic fluids, reflecting the daily urine and electrolyte losses of the average child.11 In 2003, we questioned the safety of this traditional approach, arguing that it was unphysiologic to … Address correspondence to Michael L. Moritz, MD, Division of Nephrology, Children's Hospital of Pittsburgh of UPMC, One Children's Hospital Drive, 4401 Penn Ave, Pittsburgh, PA 15224. E-mail: moritzml{at}upmc.edu