Abstract
Background and objectives: Hyponatremia often occurs among children with bronchiolitis. It is the most common electrolyte abnormality associated with severe disease course. Aim was to study relation between sodium levels and severity of bronchiolitis
 Methodology: Cross-sectional study was conducted on 72 infants admitted with bronchiolitis to Pediatrics ward/ICU, JMMC. Infants with recurrent respiratory or super added bacterial infections, born <34weeks gestation, any chronic disorder or medications that can influence electrolyte levels or parents unwilling for consent were excluded. Severity of bronchiolitis was scored and classified into mild, moderate, severe. Sodium levels were determined and grouped (in mmol/L) into normonatremia (135-145) and hyponatremia (mild (130-134), moderate (125-129) and severe (≤124). The grade of hyponatremia with severity of bronchiolitis was compared. Chi square test was used to test the association of severity of bronchiolitis and category of hyponatremia. ANOVA test was done to compare the severity of bronchiolitis with sodium levels.
 Results: Hyponatremia was seen in 50% of cases admitted with severe bronchiolitis, which when compared to mild and moderate bronchiolitis, was statistically significant (p<0.001). ANOVA showed mean sodium levels of mild, moderate and severe bronchiolitis were 138.44±1.81, 137.37±1.76 and 135.43±3.93 respectively; these were statistically significant (p<0.001). A pairwise comparison between mild and moderate bronchiolitis with hyponatremia was not found to be statistically significant (p-0.769) but comparison between mild and severe bronchiolitis with hyponatremia was statistically significant (p<0.001)
 Conclusion: There is statistically significant relation between hyponatremia and severity of bronchiolitis. Hyponatremia could be considered as a marker to assess the severity of bronchiolitis.
 Keywords: Bronchiolitis, Hyponatremia, Respiratory distress
Highlights
Bronchiolitis is a virus-induced inflammation of bronchioles and their surrounding tissue
Management is primarily supportive treatment, i.e. oxygen, nasal suctioning, mechanical ventilation and hydration.[7]. High flow oxygen therapy using nasal cannula has shown promising results.[8]. Hyponatremia often occurs among children with bronchiolitis.[9]. It is the most common electrolyte abnormality seen and associated with more severe disease course such as mechanical ventilation and increased ICU length of stay. [10]Thirst and antidiuretic hormone maintain circulating Na+ between 135 and 145mmol/L.(11) Regulation of fluid volume is controlled by the renin-angiotensin-aldosterone system, which promotes renal Na+ retention, by the natriuretic peptides, which promote Na+-wastage and by the anti-diuretic hormone, which promotes water retention.[12]. In acute lower respiratory tract infections, extracellular fluid volume depletion might result from poor fluid intake, excessive sweating, or vomiting
(52.8%), which is in accordance with study by Martinez FD et al which showed that bronchiolitis mainly affects male children.[17]. Majority of the affected children were less than 6 months of age (50%) which is similar to the study conducted by Boyce et al, which revealed that children less than 6 months of age contracted bronchiolitis of the severe kind and required higher rates of hospitalisation[18]
Summary
Bronchiolitis is a virus-induced inflammation of bronchioles and their surrounding tissue. Management is primarily supportive treatment, i.e. oxygen, nasal suctioning, mechanical ventilation and hydration.[7] High flow oxygen therapy using nasal cannula has shown promising results.[8] Hyponatremia often occurs among children with bronchiolitis.[9] It is the most common electrolyte abnormality seen and associated with more severe disease course such as mechanical ventilation and increased ICU length of stay. Hyponatremia often occurs among children with bronchiolitis It is the most common electrolyte abnormality associated with severe disease course. Results: Hyponatremia was seen in 50% of cases admitted with severe bronchiolitis, which when compared to mild and moderate bronchiolitis, was statistically significant (p
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