Hyponatremia In Children Research Articles

Efficacy of oral sodium chloride in reducing the incidence of hyponatremia in children with epilepsy receiving oxcarbazepine monotherapy: A randomized controlled trial (SCHO Trial)

IntroductionHyponatremia is a well-documented adverse effect of oxcarbazepine treatment, but no clinical trial has yet been conducted to explore any intervention for reducing the incidence of hyponatremia. Materials and MethodsThis open-label trial evaluated the efficacy of add-on daily oral sodium chloride supplementation of 1–2 g/day for 12 weeks in reducing the incidence of hyponatremia in children receiving oxcarbazepine monotherapy aged 1–18 years. Apart from comparing the incidence of symptomatic and severe hyponatremia, serum and urine sodium levels, serum and urine osmolality, changes in behavior and cognition, and the number of participants with recurrence of seizures and requiring additional antiseizure medication (ASM) were also compared. ResultsA total of 120 children (60 in each group) were enrolled. The serum sodium level at 12 weeks in the intervention group was higher than that of the control group (136.5 ± 2.6 vs 135.4 ± 2.5 mEq/L, p = 0.01). The number of patients with hyponatremia was significantly lower in the intervention group (4/60vs14/60, p = 0.01). However, the incidence of symptomatic and severe hyponatremia (0/60vs1/60, p = 0.67 for both), changes in social quotient and child behavior checklist total score (0.6 ± 0.8 vs 0.7 ± 0.5, p = 0.41 and 0.9 ± 1.2 vs 1.1 ± 0.9, p = 0.30 respectively), the number of patients with breakthrough seizures (9/60vs10/60, p = 0.89), and the number of patients requiring additional ASMs (8/60vs10/60, p = 0.79) were comparable in both groups. ConclusionsDaily oral sodium chloride supplementation is safe and efficacious in reducing the incidence of hyponatremia in children with epilepsy receiving oxcarbazepine monotherapy. However, sodium chloride supplementation does not significantly reduce more clinically meaningful outcome measures like symptomatic and severe hyponatremia.Trial registry No. CTRI/2021/12/038388.

Relationship of severity of hyponatremia and adverse outcomes in children visiting the emergency department.

Mild hyponatremia is often found in patients visiting pediatric emergency departments (PEDs), but there are few large-scale studies on its association with adverse outcomes, including mortality. We conducted this study to identify the association of mild hyponatremia with adverse outcome. This retrospective observational study included children under 18 years of age visiting the PED at a tertiary hospital. We used electronic medical record data from January 1, 2009 to December 31, 2020. Clinical outcomes, including ward admission, vasopressor administration, pediatric intensive care unit (PICU) admission, and mortality, were assessed for the total of 44,147 patients. Among these, 1,639 (3.7%) were in the hyponatremia group, with 1,521 (3.4%) exhibiting mild hyponatremia. Mild hyponatremia was more prevalent in younger patients, particularly in the 1-3 years age group, and less common in females. Patients with mild hyponatremia had a significantly prolonged median length of stay in the PED compared to normonatremic patients (5.8 h vs. 4.4 h, p < 0.001). Moreover, they showed significantly higher rates of ward admission (51.1% vs. 35.6%, p < 0.001), vasopressor administration (1.1% vs. 0.6%, p = 0.014), PICU admission (2.4% vs. 1.0%, p < 0.001), and mortality (1.5% vs. 0.3%, p < 0.001). Compared with the normonatremia group, the odds ratios (95% CI) for ward admission, vasopressor administration, PICU admission, and mortality in the mild hyponatremia group were 1.90 (1.71-2.10), 1.91 (1.17-3.13), 2.62 (1.86-3.68), and 5.56 (3.51-8.80), respectively. Furthermore, our findings demonstrate a notable upward trend in adverse outcomes, including vasopressor administration, PICU admission, and mortality, from mild hyponatremia to severe hyponatremia. In conclusion, we found that adverse outcomes increase with the severity of hyponatremia in children presenting to the PED, highlighting the importance of immediate intervention alongside the identification of the underlying cause.

Tolvaptan: a possible preemptive treatment option in children with autosomal dominant polycystic kidney disease?

Tolvaptan is a highly selective vasopressin receptor 2 antagonist that regulates cyclic adenosine monophosphate levels to inhibit both epithelial cell proliferation and chloride ion excretion, two mechanisms known to induce cyst expansion in autosomal dominant polycystic kidney disease (ADPKD). Tolvaptan is currently the preferred treatment of rapidly progressive disease ADPKD in adult patients; however, since cyst formation in ADPKD begins early in life, (frequently in utero), and significant disease progression with cyst expansion occurs in the first decade, tolvaptan may be advantageous as a preemptive treatment in children with ADPKD. Tolvaptan has already been used to successfully treat refractory edema or hyponatremia in children; this literature review provides insight into the biochemical basis of its action to contextualize its use in the pediatric population.

Midodrine reduces new-onset acute kidney injury and hyponatremia in children with cirrhosis and ascites awaiting liver transplantation: Results from an open-label RCT.

Midodrine, an oral α-1-adrenergic receptor agonist, counters arterial hypovolemia and reduces complications in adult patients with cirrhosis. This randomized controlled trial (RCT) aimed to assess the efficacy and safety of midodrine in preventing complications and improving survival in children with cirrhosis and ascites who are awaiting liver transplantation (LT). This open-label RCT conducted from January 2022 to May 2023 included children under 18 years with cirrhosis and ascites. Patients were randomized to receive either midodrine plus standard medical therapies (SMTs) or SMT alone. The primary outcome measure was the incidence of cirrhosis-related complications within 6 months. Thirty-five subjects were enrolled and randomized. Patients in the midodrine arm had a lower incidence of new-onset acute kidney injury (AKI) compared with the SMT arm (11.1% vs. 41.2%). Patients in the midodrine arm showed a decline in serum creatinine and improvement in glomerular filtration rate, whereas no changes were observed in the SMT arm. There was a lower incidence of new-onset hyponatremia in the midodrine arm (20% vs. 56%). Midodrine led to reduction in plasma rennin activity (PRA) and improvement in systemic hemodynamics. There was no difference in the rate of resolution of ascites, recurrence of ascites, requirement of therapeutic paracentesis, cumulative albumin infusion requirement, episodes of spontaneous bacterial peritonitis, and hepatic encephalopathy between the two arms. Midodrine, when added to SMT, was effective in reducing the incidence of new-onset AKI and hyponatremia in pediatric cirrhotics awaiting LT. It also improved systemic hemodynamics and showed a trend towards reducing PRA.

The prevalence and outcomes of hyponatremia in children with COVID-19 and multisystem inflammatory syndrome in children (MIS-C).

To assess the prevalence of hyponatremia among pediatric patients with coronavirus disease 2019 (COVID-19) and Multisystem Inflammatory Syndrome in Children (MIS-C) and determine if pediatric hyponatremia was associated with an increased length of stay, higher rates of mechanical ventilation, and/or elevated inflammatory markers on admission as compared to eunatremic patients. Electronic health records were retrospectively analyzed for 168 children less than 18 years old with COVID-19 or MIS-C who were admitted to pediatric units within the Northwell Health system. The primary exposure was hyponatremic status (serum sodium <135 mEq/L) and the primary outcomes were length of stay, mechanical ventilation usage and increased inflammatory markers. Of the 168 children in the study cohort, 95 (56%) were admitted for COVID-19 and 73 (43.5%) for MIS-C. Overall, 60 (35.7%) patients presented with hyponatremia on admission. Patients with hyponatremia had higher rates of intensive care unit admission when compared to eunatremic patients (32/60 [53.3%] vs. 39/108 [36.1%], p = 0.030). In regression models, hyponatremia was not significantly associated with increased length of stay or mechanical ventilation rates. After adjustment for relevant confounders, hyponatremia remained associated with an increased square root CRP (β = 1.79: 95% CI: 0.22-3.36) and lower albumin levels (β = -0.22: 95% CI: -0.42--0.01). Hyponatremia is common in pediatric COVID-19 and MIS-C. Hyponatremia was associated with a lower albumin and higher square root CRP levels. This may suggest an association of inflammation with lower serum sodium levels.

The prevalence and prognostic effect of hyponatremia in children with COVID-19 pneumonia: a retrospective study.

The aim of the study was to examine the effect of hyponatremia at admission as a negative prognostic factor in children hospitalized with COVID-19 pneumonia. The data of patients aged 1 month-18 years, who were followed with the diagnosis of pneumonia at Çanakkale Onsekiz Mart University Hospital, Department of Pediatrics, between January 2018 and May 2021 were examined, retrospectively. Patients (n=661) were divided into two main groups; COVID-19 pneumonia (n=158) and the other pneumonias [other viral pneumonia (n=161) and pneumonia of unknown etiology (n=342)]. Six hundred and twenty-three patients with a median (Q1-Q3) age of 4 (1.5-8) years, 59.4% of whom were male were included in the study. The overall prevalence of hyponatremia at admission was 11.2% and was lower in those with COVID-19 pneumonia than in those with other viral pneumonia (6.4% vs. 15.2%, p=0.013). When evaluated irrespective of their COVID-19 status, hyponatremic patients had a higher supplemental oxygen requirement (OR 2.5 [1.4-4.3], p < 0.001), higher need for intensive care unit (ICU) admission (OR 3.7 [1.3-10.2], p=0.009) and longer duration of hospitalization (p=0.016) than the normonatremic patients. In patients with COVID-19 pneumonia, being hyponatremic had no effect on supplemental oxygen requirements or the duration of hospitalization. When hyponatremic patients were evaluated, the supplemental oxygen requirements and duration of hospitalization of those with COVID-19 pneumonia were similar to the other pneumonias (p > 0.05 for all comparisons). However, normonatremic COVID-19 pneumonias had higher supplemental oxygen requirements than other viral pneumonias and pneumonia of unknown etiology (OR 4.7 [2.2-10.3], p < 0.001; OR 1.6 [1 -2.7], p=0.043, respectively). This study found that hyponatremia at admission is rarer in children with COVID-19 pneumonia than other viral pneumonias and has no effect on supplemental oxygen requirements or the duration of hospitalization.

Hyponatraemia – diagnostic difficulties in 2.5-year-old boy with nephrogenic syndrome of inappropriate antidiuresis. Case report

Normal sodium levels in the extracellular fluid are in the range of 135–145 mmol/L. Low serum sodium (hyponatraemia) is a common water and electrolyte balance disorder. Dehydration and overhydration are the most common causes of hyponatraemia in children. This paper describes a case of a 2.5-year-old boy admitted to the paediatric ward due to pneumonia. The child showed reluctance to fluid intake, hypoosmolar hyponatraemia with hypouricaemia, and increased urinary sodium excretion in the absence of abnormalities in hydration status. He had a family history of persistent hyponatraemia and hypertension in his grandfather. After excluding pituitary, thyroid, adrenal cortex pathologies, kidney disfunction, and proliferative processes in the differential diagnosis, cerebral salt wasting syndrome, the syndrome of inappropriate secretion of antidiuretic hormone and the renal-related syndrome of inappropriate antidiuresis were taken into account. The aim of the study was to discuss the differential diagnosis of chronic euvolemic hyponatraemia and to draw attention to the need for genetic testing for the nephrogenic syndrome of inappropriate antidiuretic hormone secretion caused by activating point mutations of the vasopressin 2 receptor gene (V2R).

Hyponatremia after craniotomy in children: a single-institution review.

Hyponatremia after craniotomy can be associated with increased morbidity. However, the incidence of and factors associated with post-craniotomy hyponatremia in children are not known. We performed a retrospective cohort study of patients aged 0-21years who underwent craniotomy in 2017-2019 at a single center to determine the incidence of and to identify risk factors for hyponatremia after craniotomy. Indications for craniotomy included tumors (excluding craniopharyngioma), epilepsy, intracranial infection, trauma, craniofacial, suboccipital decompression for the treatment of Chiari malformation, and cerebrovascular disease. Hyponatremia was defined as a serum sodium level ≤ 135mEq/L any time during the postoperative hospital stay. Statistical significance was defined a priori at p < 0.05. Postoperative hyponatremia occurred in 61 (25%) of 240 children. On univariate analysis, hyponatremia was associated with younger age (8.5 vs 6.3years, p = 0.01), use of preoperative anti-epileptic drugs (p = 0.02), need for blood transfusion (p = 0.02), government/private insurance (p = 0.04), and pre-existing hydrocephalus, defined as the requirement for permanent cerebrospinal fluid (CSF) diversion (p = 0.04). On multivariate analysis, only hydrocephalus (OR 2.95, 95% CI 1.03-8.40) remained statistically significant. Hyponatremia most occurred on the first postoperative day, with normonatremia achieved in a median of 14 (IQR 9.8-24.3) h. Hyponatremia was significantly associated with longer length of stay (median 8 vs 3days, p < 0.01). Hyponatremia was present in 25% of children after craniotomy. Preoperative hydrocephalus as an independent risk factor for hyponatremia after craniotomy.

Frequency of Hyponatremia in Children With Bronchiolitis

Background: Bronchiolitis is predominant among infants and mostly caused by respiratory syncytial virus (RSV). Respiratory illnesses are related to elevated anti-diuretic hormone which in turn leads to hyponatremia (&lt;135 mmol/L) Aim: To find hyponatremia frequency in bronchiolitis children. Methods: From December 8, 2017 to June 8, 2018, researchers from the pediatrics department of Lahore General Hospital/Post Graduate Medical Institution conducted a cross-sectional study. All 246 cases meeting inclusion criteria were taken from department of Pediatrics, Lahore General Hospital, Lahore. After taking informed consent all the basic information like age, sex and contact detail was taken. Blood sample sent to hospital laboratory to evaluate serum sodium levels to find hyponatremia as per operational definition. Data input and analysis were carried out using SPSS version 20. Results: With ages ranging from 2 to 24 months, the mean age was 13.29 6.35 months. There were 124(50.4%) male and 122(49.6%) female cases and male to female ratio was the same. The mean Na level in all cases was 130.86 ± 6.61 mEq/L with minimum and maximum value as 115 and 145 mEq/L respectively. A total of 192(78%) cases had hyponatermia while other 54(22%) cases had normal Na+ level. Conclusion: According to findings of this study it was concluded that frequency of hyponatermia was too high in children with Bronchiolitis i.e. 78%. So when a child present with Bronchiolitis he must be evaluated for Na+ level, and if it is low then sodium levels should also be corrected along with the treatment of bronchiolitis. Keywords: Bronchiolitis, Electrolyte imbalance, Hyponatermia, ICU, treatment prognosis.

Treatment of hyponatremia in children with acute bacterial meningitis.

PurposeFew studies have evaluated hyponatremia management in children with bacterial meningitis (BM). Thus, we aimed to describe variations in clinical practice, the effectiveness of sodium management, and adverse outcomes in children with BM and hyponatremia.MethodsThis retrospective cross-sectional study conducted at a tertiary institution analyzed participants' demographic, clinical, and sodium-altering treatment data. The sodium trigger for treatment was defined as pretreatment sodium level, with response and overcorrection defined as increments of ≥5 and >10 mmol/L after 24 h, respectively.ResultsThis study enrolled 364 children with BM (age: <16 years; 215 boys). Hyponatremia occurred in 62.1% of patients, among whom 25.7% received sodium-altering therapies; 91.4% of those individuals had moderate/severe hyponatremia. Monotherapy was the most common initial hyponatremia treatment. After 24 h of treatment initiation, 82.4% of the patients responded. Logistic regression analyses revealed that ΔNa24 <5 mmol/L [odds ratio (OR) 15.52, 95% CI 1.71–141.06, p = 0.015] and minimum Glasgow Coma Scale (GCS) score ≤ 8 (OR 11.09, 95% CI 1.16–105.73, p = 0.036) predicted dysnatremia at 48 h after treatment initiation. Although rare, persistent moderate/severe hyponatremia or hypernatremia at 48 h after treatment initiation was associated with a high mortality rate (57.1%).ConclusionThis study found that most cases of hyponatremia responded well to various treatments. It is important to identify and institute appropriate treatment early for moderate or severe hyponatremia or hypernatremia in children with BM. This study was limited by its non-randomized nature.

Incidence and Risk Factors for Hyponatremia in Hospitalized Children with Lower Respiratory Tract Infections

Lower respiratory tract infection (LRTI) is an important cause of hospitalization in pediatric population. Hyponatremia is frequently present in children hospitalized with pneumonia and bronchiolitis and is associated with poorer outcomes. We conducted a study to identify the risk factors for hyponatremia in hospitalized children with LRTI and to evaluate the relationship between serum sodium levels and severity of respiratory distress. A total of 147 patients between 2 months and 12 years of age, admitted with the diagnosis of LRTI at the Mahatma Gandhi Mission Hospital and Medical College, a tertiary hospital in Navi Mumbai, Maharashtra, India, between December 2017 and November 2019, were studied prospectively. Patients with any other comorbidities were excluded. The severity of respiratory distress at presentation was graded using the Clinical Respiratory score (CRS). Serum electrolytes were sent within 1 hour of hospital admission. Median age of enrolled patients was 14 months. Overall, 23 (16%) children had mild respiratory distress, 97 (66%) had moderate respiratory distress, and 26 (18%) had severe distress. The incidence of hyponatremia in children admitted with LRTI was 66% and majority of them (70%) had mild hyponatremia. The incidence, as well as severity of hyponatremia differed significantly with etiology (p &lt; 0.05). An inverse correlation was found between serum sodium levels and CRS at presentation (r = − 0.26, p = 0.001). In multivariate analyses, parenchymal disease was an independent risk factor for development of hyponatremia (adjusted odds ratio [aOR] = 5.64 (2.52–12.59), p &lt; 0.001). Incidence and severity of hyponatremia in children with LRTI increased with severity of respiratory distress and presence of parenchymal disease.

Analysis of Risk Factor Hypoalbuminemia on the Incidence of Hyponatremia in Children with Nephrotic Syndrome

Background: Nephrotic syndrome is a clinical condition characterized by massive proteinuria, hypoalbuminemia, edema and may be accompanied by hypercholesterolemia. Proteinuria in childhood nephrotic syndrome is mainly in the form of albuminuria. In nephrotic syndrome, electrolyte balance disorders can occur in the form of hyponatremia which can cause complications from asymptomatic clinical manifestations to death. Currently, there are not many studies on hyponatremia in nephrotic syndrome. Objective: To determined hypoalbumin as a risk factor for hyponatremia in children with nephrotic syndrome. Methods: This research was an analytic observational study using a case control design. The subjects consisted of 80 children diagnosed with nephrotic syndrome at the Children's Health Installation at the Dr. Sardjito in Yogyakarta. The data collected included serum albumin levels and sodium levels. Statistical test using Odds Ratio (OR). .Results: The results showed that hypoalbumin (p = 0.000 ; OR 13,5; 95% CI 3,395 – 53,68) was a risk factor for the incidence of hyponatremia in children with nephrotic syndrome at the Children's Health Unit, Dr. Sardjito General Hospital in Yogyakarta. Conclusion: Hypoalbumin is a risk factor for hyponatremia in children with nephrotic syndrome

A PROSPECTIVE STUDY ON HYPONATREMIA IN CHILDREN WITH THE LOWER RESPIRATORY TRACT INFECTIONS ADMITTED IN PICU

Objective: The present study has been undertaken to study hyponatremia in children with lower respiratory tract infections. The other objectives of the study were to evaluate the clinical and laboratory characteristics of children with hyponatremia and explore the relationship between hyponatremia and outcome about the duration of hospital stay and recovery/death. Methods: The study included children aged 2 months to 5 years who were referred to the PICU, GITAM Institute of Medical Sciences and Research, Visakhapatnam from October 2018 to September 2019 with the lower respiratory tract infections were included in the study. A thorough clinical examination and detailed history have been completed and recorded into a prestructured pro forma. Hematological investigations have been done in all cases. Chest X-ray has been done in all cases to delineate the radiological features of LRTI. A venous blood sample was collected and sent to the biochemistry lab to evaluate serum sodium and was estimated by the ion-selective electrode method analyzed by the radiometer. Results: 872 children were admitted to the pediatric intensive care unit during the study period. Among them, 100 children in the age group of 2 months to 5 years suffering from the lower respiratory tract infection were included in the study. Out of 100 cases of the lower respiratory tract infections, 59 cases were Pneumonia, and 41 cases were severe Pneumonia. Out of 100 cases, 68 cases accounting for 68% have normal sodium levels, 32 cases accounting to 32% had hyponatremia, and none had hypernatremia. Thus, third of the cases suffering from the lower respiratory tract infections had hyponatremia. The mean CRP in children with hyponatremia was 7.38 mg/dl, higher than children with normal sodium levels, that is, 2.30 mg/dl; this was also statistically significant (p&lt;0.001). All 32 cases of hyponatremia and 68 cases of normonatremia recovered and were discharged. There was no mortality. Conclusion: Children with hyponatremia had a longer duration of hospital stay. Serum sodium levels are an important biomarker and should be measured in all children hospitalized for the lower respiratory tract infections.

Outdoor temperature and circulating sodium in children with acute gastroenteritis.

Dysnatremias are frequent in acute gastroenteritis. High outdoor temperatures have been associated with hyponatremia in both adults and the elderly, but no data are available among children with gastroenteritis. Children <10 years of age admitted to the emergency department of the Policlinico Hospital, Milan (Italy) between 2009 and 2019 with acute moderate-severe gastroenteritis were enrolled. The association between hyponatremia (sodium < 135 mmol/L) and daily mean levels of temperature or apparent temperature from day of admission up to 14 days before was analyzed by multivariable logistic regression models. In 202 included children (46% females), we observed an increased risk of hyponatremia per unit increase in outdoor temperature of the sixth, eighth and ninth day before admission [Odds Ratio = 1.24 (95% Confidence Interval: 1.04-1.47), 1.14 (1.01-1.28), and 1.14 (1.01-1.28), respectively]. Analyses considering average temperature levels of the ten days preceding admission returned similar findings as well as those on apparent temperature. Our data suggest the existence of an association between outdoor temperature and circulating sodium levels in children with acute gastroenteritis. The role of meteorological conditions on electrolyte imbalance should be further explored in the context of climate change. The role of meteorological variables in the development of dysnatremias has been demonstrated in children and adolescents with cystic fibrosis. This study shows for the first time that higher outdoor temperatures are associated with a higher risk of hyponatremia in children with gastroenteritis. In the context of climate change, the role of external climate conditions on the risk of electrolyte imbalance in children should be more and more considered and explored in future studies.

Frequency and Severity of Hyponatremia in Children Seeking Emergency Care

Objective: To determine the frequency and severity of hyponatremia in children seeking emergency care at tertiary care Hospital. Methodology: This cross-sectional study was done at Pediatric emergency civil Hospital Karachi from May 2012 to November 2012. All patients of either sex coming to pediatric emergency, ages from 2 months to 12 years who did not receive any treatment during this illness were included. All patients who met the inclusion criteria were evaluated for sodium concentration through serum sodium concentration. Informed consent was obtained from the parents or attendant. Data was analyzed using SPSS version 26. Results: The mean age of enrolled participants was 4.1±2.7 year. Of 188 enrolled participants, 144 (76.6%) were male and 44 (23.4%) were female with a male to female ratio of 2.3:1, mean weight 12.87±3.5 kg and mean serum sodium level of 134.64±3.7mEq/L. The frequency of hyponatremia was in 61(32.4%) cases and out of these 61 patients, 18.9% had severe hyponatremia. The frequency of hyponatremia was statistically insignificant according to age and gender (p-&gt;0.05). Conclusion: It was concluded that the frequency of hyponatremia in sick children presented to emergency department was 32.4%. Key words: Hyponatremia, Children, Emergency department

Особливості діагностики та лікування гіпонатріємії в дітей

У даній статті розкриваються механізми регуляції обміну натрію, причини розвитку гіпонатріємії та пов’язані з нею патофізіологічні зміни в організмі, а також сучасні підходи до діагностики та інтенсивної терапії даного стану в дітей.

0.45% Versus 0.9% Saline in 5% Dextrose as Maintenance Fluids in Children Admitted With Acute Illness: A Randomized Control Trial.

The safety of giving intravenous (IV) maintenance fluids according to Holliday and Segar's recommendations of 1957 has recently been questioned after reports of complications caused by iatrogenic hyponatremia in children receiving hypotonic fluids. However, the current practice of choice of maintenance IV fluids for hospitalized children varies worldwide. This study was planned to compare 0.45% and 0.9% saline in 5% dextrose at standard maintenance rates in hospitalized children aged 3 months to 12 years. Primary objective was to study change in serum sodium level at 24 hours in children receiving total IV fluid maintenance therapy as 0.45% or 0.9% normal saline in 5% dextrose. Secondary objectives of this study were to estimate change in serum sodium levels from the baseline to 48 or 72 hours, if IV fluids were continued, and to find incidence of hyponatremia and hypernatremia after administering these 2 types of maintenance fluids. This study was an open-label, randomized control trial conducted at the Department of Pediatrics of a tertiary care hospital from July 22, 2019, to October 28, 2019. Two hundred children aged 3 months to 12 years admitted in pediatric emergency and requiring IV maintenance fluid were randomized into 2 groups (group A received 0.45% saline in 5% dextrose, group B received 0.9% normal saline in 5% dextrose) with 100 in each group. Both groups were comparable for baseline characteristics. Fall in mean serum sodium from baseline was more with increasing duration of IV fluids until 24 hours in 0.45% saline group as compared with 0.9% saline group, which was statistically significant (P < 0.001). The incidence of mild and moderate hyponatremia was significantly more in hypotonic group at 12 hours (P < 0.001) and 24 hours (P < 0.001). However, there was no significant difference at 48 hours. The fall in serum sodium values was significant, and there was significant risk of hyponatremia with the use of hypotonic fluids at 12 and 24 hours. Hence, the use of isotonic fluids seems to be more appropriate among the hospitalized children.Trial Registration: CTRI/2019/10/021791.

Serum sodium level is inversely correlated with body temperature in children.

Several studies have demonstrated that non-osmotic antidiuretic hormone activity contributes to the development of hyponatremia in children with common febrile diseases. However, the relationship between hyponatremia and body temperature has remained unclear. We therefore examined this relationship in children with common diseases. In this retrospective case study based on a chart review, 1,973 children presenting with acute illnesses at Hirakata City Hospital between November 2008 and October 2009, and for whom blood test data were available, were enrolled. The median age of this cohort was 2.7 years and the mean serum sodium concentration was 136.4 mEq/L; 454 patients showed hyponatremia (<135 mEq/L). The patients were classified into four groups on the basis of body temperature, <37 °C, 37 °C (37.0-37.9 °C), 38 °C (38.0-38.9 °C) and ≥39 °C, and their serum sodium concentration was compared. The mean sodium level was significantly lower in febrile (135.9 mEq/L) than in non-febrile (138.5 mEq/L) patients. The mean serum sodium levels in the four temperature groups were, in ascending order, 138.5 mEq/L (95% CI, 138.3-138.8 mEq/L), 137.3 mEq/L (137.1-137.5 mEq/L), 136.1 mEq/L (135.8-136.3 mEq/L) and 134.6 mEq/L (134.4-134.9 mEq/L), respectively. The serum sodium level in each individual temperature range became significantly lower as body temperature increased (P < 0.001). There is a clear inverse correlation between serum sodium level and body temperature in children with common febrile diseases, and fever may play an important role in this relationship.

Risk Factors of Hyponatremia in Children with Lower Respiratory Tract Infection (LRTI)

Risk Factors of Hyponatremia in Children with Lower Respiratory Tract Infection (LRTI)

Гипонатриемия у детей с острой хирургической патологией

В данной статье изложены результаты исследования частоты развития, степени выраженности и тяжести гипонатриемии у детей с острой хирургической патологией. Определена частота влияния синдрома неадекватной секреции антидиуретического гормона на развитие гипонатриемии.