Hyponatremia in critically ill mechanically ventilated children
Keywords:Hyponatremia, Critically ill, Children
Background:Hyponatremia is a serious adverse event in the paediatric critical care population is especially complex as many patients require multiple continuous infusion and excess fluid volumes due to hypovolemic shock or blood pressure instability. Acute hyponatremia poses an immediate danger to the central nervous system. Administration of hypotonic maintenance fluids may worsen this. Hyponatremia can eventually lead to seizure and death depending magnitude and severity of onset. Hyponatremia is a common electrolyte disturbance occurring in critically ill patients. Symptoms range from nausea and malaise, with mild reduction in the serum sodium, to lethargy, decreased level of consciousness, headache, seizures and coma. The treatment of hyponatremia depends on the duration of hyponatremia and volume status of the patients. There is serious neurologic sequel if hyponatremia is inappropriately treated.
Methods: The present retrospective observational study was conducted in the pediatric ICU ward of Department of Pediatrics at Dr. B.R.A.M. Hospital associated Pt. J.N.M. Medical College, Raipur (C.G.), India during study period from April 2015 to September 2015. The study was carried out hyponatremia in children between the age group of >1 months to 13 years presenting with critically illness need mechanical ventilation admitted in ICU were included in the study. Sample size was fixed at 84. The patient’s clinical data were recorded in all the cases. Investigations were done on the day of admission in who were clinically critically ill and had an initial serum sodium value <135 mEq/L. Data was expressed as mean ± S.D. and percentage depending on distribution of data and as percentage.
Results:In the current study, maximum admitted subjects belonged to infancy (<1year) 31 subjects (35.7%), 17 of them were male and 14 were female. Out of total subjects 49 (58.3%) were male and 35 (41.7%) were females. Distribution of disease associated was studied in the subjects and maximum subjects were found to be suffering from septicemia (19 subjects, 22.6%). Frequency of hyonatremia is more (77.4%) in age group less than 1 year. Already admitted subjects showed significantly higher duration of illness (23.7±59.3 days) compared to newly admitted subjects (9.4±19.8 days). Incidence rate of mild hyponatremia is more (52%). Significant difference was noted in IV Fluids administered in study subjects who were previously admitted and newly admitted.
Conclusions:Current study denotes hyponatremia is a common finding in critically sick patients, it is more common in infants and patients with MODS &Meningoencephalitis diseased and so we need to be highly vigilant in these children.
Nelson’s text book of paediatrics, 20th edition, South-Asian edition. PArt-VII. Chapter-52. Elsevier publication; 2015:212-218.
Singh M. Emergency paediatrics, 5th edition. Section-1, Chapter-5. CBS publisher:2016;64-89.
Guruswamy NT, Khan H, Hegde P. Correlation of hyponatremia in children presenting with acute lower respiratory tract infection in a tertiary care hospital. Intern J Recent Trends Sci Tech. 2014;12(3):631-4.
Padhi R, Panda BN, Jagati S, Patra SC. Hyponatremia in critically ill patients. Indian J Crit Care Med. 2014;18(2):83-7.
Sample size calculator. Available at http://www.surveysystem.com/sample-size-formula.html. Accessed on 15 May, 2016.
Sterns RH, Silver SM, Spital A. Hyponatremia. In: Seilden DW, Giebish G, eds. The Kidney: Physiology and Pathophysiology. Philadelphia: Lipincott Williams & Wikins; 2000:1117-1138
Don M, Valerio G, Korppi M, Canciani M. Hyponatremia in pediatric community-acquired pneumonia. Pediatr Nephrol. 2008;23:2247-53.
Ray PE, McBryde KD, Newman KD, Weinstein SL, Bell MJ. Incidence of postoperative hyponatremia and complications in critically-ill children treated with hypotonic and normotonic solutions. The J Pediatr. 2008;152(1):33-8.
Fenk GC, Linder G, Druml W, Metnitz B, Schwarz C, Bauer P, et al. Incidence and Prognosis of dysnatremia present on ICU admission. Intensive care Med. 2010;36:304-11.
Singhi S, Jayashree M. Free water excess is not the main cause of hyponatremia in critically ill patients receiving conventional maintenance fluids. Indian Pediatr. 2009;46:577-83.
Jayashree M, Balaaji MAR. Choice of maintanence fluid- does it hold water. Indian Pediatr. 2014;51:963-4.
Valentine SL, Sapru A, Higgerson RA, Spinella PC, Flori HR, Graham DA, et al. Fluid balance in critically ill children with acute lung injury. Crit Care Med. 2012;40(10):2883-9.