Introduction: Pneumonia has been the leading cause of mortality in children. Among the various complications of pneumonia, hyponatremia has often been overlooked which incidentally happens to be the commonest and life threatening as well. There are several reports on high prevalence of hyponatremia in the western countries as an indicator of severity of pneumonia. These researches have been lacking in Nepal. Objectives: The objectives of this study was to determine the prevalence of hyponatremia in children between 2 months to 5 years of children with radiologically or clinically proven pneumonia admitted at Birat Medical College & Teaching Hospital (BMCTH) and also to investigate the relationship between serum sodium level and other laboratory parameters. Methodology: A descriptive cross-sectional study was carried out at BMCTH on children aged 2 months to 5 years admitted with pneumonia. Those who met the inclusion criteria were included. History and physical examination was done to confirm diagnosis and classify the severity of pneumonia on the basis of WHO classification. A 2ml blood sample was then withdrawn from the patient and taken to the laboratory for serum sodium as well as other relevant parameters. Results: A total of 50 children of age ranging from 2 months to 5 years who were admitted with clinical or radiological diagnosis of pneumonia were enrolled in the study. Cough was present in 76% of studied children while fever was present in 92%. Clinical diagnosis revealed majority of children with severe pneumonia (40%).Leukocytosis was seen in 70% of children while acute phase reactants CRP was positive in 86% of the children. Hyponatremia was revealed in 80% of the children with pneumonia. Among children between 2 months to 12 months 20% had severe hyponatremia while children in age group between 1 to 3 years 6% had severe hyponatremia and between 3 to 5 yrs of children 8% had severe hyponatremia. The relation was statistically not significant. Leukocytosis was demonstrated in 58% of children with hyponatremia . The relation however was not statistically significant. CRP was found positive in 76% of children with hyponatremia. This was statistically significant. There were 18% of the children who had very severe pneumonia along with severe hyponatremia. While 14% with severe hyponatremia had severe pneumonia and only 2% of the children with severe hyponatremia had pneumonia. In children with moderate hyponatremia 16% of them suffered from moderate pneumonia and 10% had very severe pneumonia and 4% had pneumonia. Among children with pneumonia 12% had pneumonia only while 2% had severe pneumonia and 6% had very severe pneumonia. Conclusion: Children admitted with clinical or radiological diagnosis of pneumonia and were assessed for sodium level. Hyponatremia was detected in children with pneumonia which was statistically significant. Hence along with management of pneumonia, hyponatremia should also be cautiously addressed in these patients.

Introduction: Birth asphyxia is an eventuality having far reaching consequences in the neonatal period. Hypoxia and ischemia can cause damage to almost every tissue and organ in the body and various target organs involved. Renal insult is a recognized complication of birth asphyxia and carries a poor prognosis. Timely detection of renal dysfunction and appropriate management may favorably alter the prognosis in many neonates with birth asphyxia. Objective: The present study was done to find out the incidence of acute renal failure in the full term neonates with birth asphyxia. Methodology: A cross sectional study was conducted at Birat Medical College Teaching Hospital, Morang, Nepal from 1st September 2017 to 28th February 2018. Fifty full term neonates born with Apgar score of <6 at 5 minutes and fulfilling inclusion criteria were enrolled in the study. Asphyxiated neonates having Serum creatinine >1.5gm/dl or urine output<1ml/kg/hr were labeled as cases of Acute Renal Failure. Blood sample for serum creatinine was collected at 24hrs, 48 hrs and 72 hrs of life. Results A total of 50 term asphyxiated neonates were enrolled in the present study. Among them 54% and 46% were males and females respectively with male to female ratio of 1.2:1. In the present study 62% of cases developed acute renal failure in either of the first three days of life with mean urine output 1.02±0.27ml/kg/hr and mean serum creatinine of 1.49±0.32 mg/dL. The incidence of oliguric renal failure was 52% and non oliguric renal failure was 48%.The association between serum creatinine and urine output was statistically significant. Conclusion: In the present study birth asphyxia has been an important cause of neonatal acute renal injury, revealing 31 (62%) cases. Monitoring urine output and serum creatinine has helped in detecting the asphyxiated neonates with acute renal injury in the early stage.