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2017, Number S1

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Rev Med Inst Mex Seguro Soc 2017; 55 (S1)

Hyponatremia and its etiology in pediatric patients admitted to the emergency room

Medrano-Rodríguez AB, Ortega-Cortés R, Torres-Infante E, Macario-Reynoso A; Barrera-de León JC

Language: Spanish
References: 38
Page: 64-70
PDF size: 295.71 Kb.


ABSTRACT

Background: The importance of hyponatremia is underestimated despite it is a frequent alteration in a hospital environment. Usually no cause is investigated and it is treated as an isolated data. The aim was to determine the prevalence and etiology of hyponatremia in pediatric patients.
Methods: Cross-sectional study of 72 patients from 1-month to 15-years of age admitted to the emergency room, from May to September, 2015, with lower serum determination of Na < 135 mEq/L at admission. For statistical analysis, frequencies and percentages, as well as medians and ranges were used.
Results: 72 patients (3%) out of 2400 admissions to the emergency room were detected. 42 were male (58%), 28 infant (30.5%), and 46 eutrophic (68.5%). The diagnosis at admission was sepsis in 13 (18%), mild hyponatremia in 41 (56.9%), real hyponatremia in 71 (98.6%) and dilutional in 1 (1.4%). The median serum sodium was 130 mEq/L (range 112- 134), and the median serum osmolality 266 mOsm/L (range 236-288). The most usual management was the increase of sodium in solutions in 21 cases (29%), and the use of diuretics (n = 21, 29%). The median of sodium input per m2 (BSA) per day was 45 mEq (range 0-158).
Conclusions: Mild and real hyponatremia were the most frequent diagnoses. The infection at admission was the more common etiology. The increase in sodium input in solution was the most common management. The use of intravenous solutions 2:1 (isotonic) did not produce hypernatremia and avoided administration of hypotonic solutions.


REFERENCES

  1. Álvarez E, González E. Bases fisiopatológicas de los trastornos del sodio en pediatría. Rev Chil Pediatr. 2014;85(3):269-80.

  2. Al-Lamki Z, A Farooqui M, Ahmed S. Incidence and Outcome of Severe Hyponatremia in Children and Young Adults. Sultan Qaboos Univ Med J. June 2006;6(1):13-6.

  3. Peruzzo M, Milani GP, Garzoni L, Longoni L, Simonetti GD, Bettineli A, et al. Body fluids and salt metabolism-Part II. Ital J Pediatr. 2010; 36: 78. doi: 10.1186/1824-7288-36-78

  4. Tzamaloukas AH, Malhotra D, Rosen BH, Raj DSC, Murata GH, Shapiro JI. Principles of Management of Severe Hyponatremia. J Am Heart Assoc. 2013; 2(3): 1-9. https://doi.org/10.1161/JAHA.112.005199

  5. Moritz ML, Ayus JC. Prevention of Hospital-Acquired Hyponatremia: Do We Have the Answers? Pediatrics. Nov 2011;128(5):980-3.

  6. García-Frade Ruíz L, Mas-Martínez AP. Actualidades en el estudio y manejo de la hiponatremia. Med Int Mex 2007;23:138-50.

  7. Velásquez, JL. Hiponatremia. Alteraciones hidroelectrolíticas en pediatría. Segunda edición. Editorial Prado. 2010. pp. 101-43.

  8. Easley D, Tillman E. Hospital-Acquired Hyponatremia in Pediatric Patients: A Review of the Literature. J Pediatr Pharmacol Ther. 2013;18(2):105-11.

  9. Skippen P, Adderley R, Benett M, Cogswell A, Froese N, Seear M, et al. Iatrogenic hyponatremia in hospitalized children: Can it be avoided? Paediatr Child Health. 2008;13(6):502-6.

  10. Andersen C, Afshari A. Impact of perioperative hyponatremia in children: A narrative review. World J Crit Care Med. 2014 Nov 4;3(4):95-101. doi: 10.5492/ wjccm.v3.i4.95.

  11. Moritz ML, Ayus JC. New aspects in the pathogenesis, prevention, and treatment of hyponatremic encephalopathy in children. Pediatr Nephrol. 2010;25(7):1225- 38. doi: 10.1007/s00467-009-1323-6

  12. Friedman JN. Risk of acute hiponatremia in hospitalized children and youth receiving maintenance intravenous fluids. Paediatr Child Health. 2013;18(2):102-4.

  13. Wang J, Xu E, Xiao Y. Isotonic Versus Hypotonic Maintenance IV Fluids in Hospitalized Children: A Meta-Analysis. Pediatrics. 2014.133(1):105-13.

  14. Sánchez-Bayle M, Martín-Martín R, Cano-Fernández J, Villalobos-Pinto E. Fluid therapy and iatrogenic hyponatremia risk in children hospitalized with acute gastroenteritis: prospective study. Nefrología. 2014;34(4):477-82.

  15. Kraft MD, Btaiche IF, Sacks GS, Kudsk KA. Treatment of electrolyte disorders in adult patients in the intensive care unit. Am J Health Syst Pharm. 2005 Aug 15;62(16):1663-82.

  16. Lagos-Martínez L, Matamoros MM, Moncada W, Félix-Rivera M. Hiponatremia en el Paciente Crítico Pediátrico. Revista Médica de los PostGrados de Medicina. Ene 2009;12(1):13-8. Disponible en http:// www.bvs.hn/RMP/pdf/2009/pdf/Vol12-1-2009-5.pdf

  17. Wattad A, Chiang ML, Hill LL. Hyponatremia in hospitalized children. Clin Pediatr (Phila). 1992;31(3):153-7.

  18. Bibi S, Bibi S, Hussain-Gilani SY, Ali-Shah SR, Haq A, Billo AG. Frequency of hospital acquired hyponatremia in a pediatric tertiary care setting. J Ayub Med Coll Abbottabad. 2015;27(3):560-3.

  19. Busto-Aguirreurreta N, Munar-Bauza F, Fernández- Jurado MI, Araujo-López A, Fernández-López E, Serrano-Casabón S et al. Recomendaciones de Fluidoterapia pre y perioperatoria en el paciente pediátrico. Rev Esp Anestesiol Reanim. 2014;61(Supl 1):1-24.

  20. McNab S, Ware RS, Neville KA, Choong K, Coulthard MG, Duke T, et al. Isotonic versus hypotonic solutions for maintenance intravenous fluid administration in children (Review). Cochrane Library. 2014, issue12. Art. No.: CD009457. DOI: 10.1002/14651858. CD009457.pub2.

  21. Friedman JN, Beck CE, DeGroot J, Geary DF, Sklansky DJ, Freedman SB. Comparison of Isotonic and Hypotonic Intravenous Maintenance Fluids: A Randomized Clinical Trial. JAMA Pediatr. 2015 May;169(5):445-51. doi: 10.1001/jamapediatrics.2014.3809.

  22. Flores-Robles CM, Cuello-García CA. A prospective trial comparing isotonic with hypotonic maintenance fluids for prevention of hospital-acquired hyponatraemia. Paediatr Int Child Health. 2015; 27:20.

  23. Prego G. Comentario sobre: Intravenous fluid management for the acutely ill child. Review. Arch Pediatr Urug. 2011;82(3):177-80.

  24. Carandang F, Anglemyer A, Longhurst CA, Krishnan G, Alexander SR, Kahana M, et al. Association Between Maintenance Fluid Tonicity and Hospital-Acquired Hyponatremia. J Pediatr. 2013 Dec;163(6):1646-51. doi: 10.1016/j.jpeds.2013.07.020.

  25. Park SJ, Shin JI. Inflammation and hiponatremia: an underrecognized condition?. Korean J Pediatr. 2013; 56(12):519-22.

  26. Las Heras-Mosteiro J, Taboada-Taboada M. Hiponatremia secundaria a diuréticos. MEDIFAM 2001;11(5):302-6. Disponible en http://scielo.isciii.es/scielo.php?script=sci_artt ext&pid=S1131-57682001000500008

  37. Álvarez E, González E. Bases fisiopatológicas de los trastornos del sodio en pediatría. Rev Chil Pediatr. 2014;85(3):269-80. 2. Al-Lamki Z, A Farooqui M, Ahmed S. Incidence and Outcome of Severe Hyponatremia in Children and Young Adults. Sultan Qaboos Univ Med J. June 2006;6(1):13-6. 3. Peruzzo M, Milani GP, Garzoni L, Longoni L, Simonetti GD, Bettineli A, et al. Body fluids and salt metabolism-Part II. Ital J Pediatr. 2010; 36: 78. doi: 10.1186/1824-7288-36-78 4. Tzamaloukas AH, Malhotra D, Rosen BH, Raj DSC, Murata GH, Shapiro JI. Principles of Management of Severe Hyponatremia. J Am Heart Assoc. 2013; 2(3): 1-9. https://doi.org/10.1161/JAHA.112.005199 5. Moritz ML, Ayus JC. Prevention of Hospital-Acquired Hyponatremia: Do We Have the Answers? Pediatrics. Nov 2011;128(5):980-3. 6. García-Frade Ruíz L, Mas-Martínez AP. Actualidades en el estudio y manejo de la hiponatremia. Med Int Mex 2007;23:138-50. 7. Velásquez, JL. Hiponatremia. Alteraciones hidroelectrolíticas en pediatría. Segunda edición. Editorial Prado. 2010. pp. 101-43. 8. Easley D, Tillman E. Hospital-Acquired Hyponatremia in Pediatric Patients: A Review of the Literature. J Pediatr Pharmacol Ther. 2013;18(2):105-11. 9. Skippen P, Adderley R, Benett M, Cogswell A, Froese N, Seear M, et al. Iatrogenic hyponatremia in hospitalized children: Can it be avoided? Paediatr Child Health. 2008;13(6):502-6. 10. Andersen C, Afshari A. Impact of perioperative hyponatremia in children: A narrative review. World J Crit Care Med. 2014 Nov 4;3(4):95-101. doi: 10.5492/ wjccm.v3.i4.95. 11. Moritz ML, Ayus JC. New aspects in the pathogenesis, prevention, and treatment of hyponatremic encephalopathy in children. Pediatr Nephrol. 2010;25(7):1225-

  38. doi: 10.1007/s00467-009-1323-6 12. Friedman JN. Risk of acute hiponatremia in hospitalized children and youth receiving maintenance intravenous fluids. Paediatr Child Health. 2013;18(2):102-4. 13. Wang J, Xu E, Xiao Y. Isotonic Versus Hypotonic Maintenance IV Fluids in Hospitalized Children: A Meta-Analysis. Pediatrics. 2014.133(1):105-13. 14. Sánchez-Bayle M, Martín-Martín R, Cano-Fernández J, Villalobos-Pinto E. Fluid therapy and iatrogenic hyponatremia risk in children hospitalized with acute gastroenteritis: prospective study. Nefrología. 2014;34(4):477-82. 15. Kraft MD, Btaiche IF, Sacks GS, Kudsk KA. Treatment of electrolyte disorders in adult patients in the intensive care unit. Am J Health Syst Pharm. 2005 Aug 15;62(16):1663-82. 16. Lagos-Martínez L, Matamoros MM, Moncada W, Félix-Rivera M. Hiponatremia en el Paciente Crítico Pediátrico. Revista Médica de los PostGrados de Medicina. Ene 2009;12(1):13-8. Disponible en http:// www.bvs.hn/RMP/pdf/2009/pdf/Vol12-1-2009-5.pdf 17. Wattad A, Chiang ML, Hill LL. Hyponatremia in hospitalized children. Clin Pediatr (Phila). 1992;31(3):153-7. 18. Bibi S, Bibi S, Hussain-Gilani SY, Ali-Shah SR, Haq A, Billo AG. Frequency of hospital acquired hyponatremia in a pediatric tertiary care setting. J Ayub Med Coll Abbottabad. 2015;27(3):560-3. 19. Busto-Aguirreurreta N, Munar-Bauza F, Fernández- Jurado MI, Araujo-López A, Fernández-López E, Serrano-Casabón S et al. Recomendaciones de Fluidoterapia pre y perioperatoria en el paciente pediátrico. Rev Esp Anestesiol Reanim. 2014;61(Supl 1):1-24. 20. McNab S, Ware RS, Neville KA, Choong K, Coulthard MG, Duke T, et al. Isotonic versus hypotonic solutions for maintenance intravenous fluid administration in children (Review). Cochrane Library. 2014, issue12. Art. No.: CD009457. DOI: 10.1002/14651858. CD009457.pub2. 21. Friedman JN, Beck CE, DeGroot J, Geary DF, Sklansky DJ, Freedman SB. Comparison of Isotonic and Hypotonic Intravenous Maintenance Fluids: A Randomized Clinical Trial. JAMA Pediatr. 2015 May;169(5):445-51. doi: 10.1001/jamapediatrics.2014.3809. 22. Flores-Robles CM, Cuello-García CA. A prospective trial comparing isotonic with hypotonic maintenance fluids for prevention of hospital-acquired hyponatraemia. Paediatr Int Child Health. 2015; 27:20. 23. Prego G. Comentario sobre: Intravenous fluid management for the acutely ill child. Review. Arch Pediatr Urug. 2011;82(3):177-80. 24. Carandang F, Anglemyer A, Longhurst CA, Krishnan G, Alexander SR, Kahana M, et al. Association Between Maintenance Fluid Tonicity and Hospital-Acquired Hyponatremia. J Pediatr. 2013 Dec;163(6):1646-51. doi: 10.1016/j.jpeds.2013.07.020. 25. Park SJ, Shin JI. Inflammation and hiponatremia: an underrecognized condition?. Korean J Pediatr. 2013; 56(12):519-22. 26. Las Heras-Mosteiro J, Taboada-Taboada M. Hiponatremia secundaria a diuréticos. MEDIFAM 2001;11(5):302-6. Disponible en http://scielo.isciii.es/scielo.php?script=sci_artt ext&pid=S1131-57682001000500008 27. Vega J, Manríquez F, Madrid E, Goecke H, Carrasco A, Martínez G et al. La hiponatremia al momento de ingreso como factor de riesgo de mortalidad hospitalaria. Rev Med Chile. 2011;139(8):985-91. Disponible en http://www.scielo.cl/scielo.php?script=sci_art text&pid=S0034-98872011000800002




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