Aim: To document the incidence and early evolution of hyponatraemia (serum sodium <136 mmol 1−1) associated with respiratory syncytial virus (RSV) bronchiolitis in infants requiring intensive care. Methods: In a retrospective review over two winter seasons, 130 infants were admitted with confirmed RSV infection, of whom 39 were excluded because of either pre‐existing risk factors for hyponatraemia: diuretic therapy (n= 14), cardiac disease (n= 10), renal disease (n= 2) or lack of admission sodium data (n= 13). Results: The incidence of admission hyponatraemia in the remaining infants (median age 6 wk) was 33% (30/91), with 11% (10/91) exhibiting a serum sodium less than 130 mmol 1−1. Hyponatraemic and normonatraemic infants were of a similar age (median 6 vs 7 wk, p= 0.82). With fluid restriction and diuretic therapy, the incidence of hyponatraemia at 48 h had decreased to 3.3%, odds ratio 0.07 (95% confidence interval 0.02–0.24, p < 0.001). Four infants (4%) suffered hyponatraemic seizures at admission (sodium 114–123 mmol 1−1); three had received hypotonic intravenous fluids at 100–150 ml kg−1 d−1 before referral to intensive care. All four were managed successfully with hypertonic (3%) saline, followed by fluid restriction, resulting in immediate termination of seizure activity and normalization of serum sodium values over 48 h. Conclusion: Hyponatraemia is common among infants with RSV bronchiolitis presenting to intensive care. Neurological complications may occur and fluid therapy in vulnerable infants should be tailored to reduce this risk.

In metabolic acidosis due to TA, plasma Cl concentration decreases relative to sodium. The Cl:Na ratio is a simple alternative to the AG for detecting TA in this setting.

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Objective-To assess the value of sequential lactate measurement in predicting postoperative mortality after surgery for complex congenital heart disease in children. Design-Prospective observational study. Setting-Sixteen bedded paediatric intensive care unit (PICU). Subjects-Ninety nine children ( 90 survivors, nine non-survivors). Measurements-Serum lactate and base deficit were measured on admission and every six hours thereafter. Data were analysed by Mann-Whitney and Fisher's exact tests.Results-There was considerable overlap in initial lactate values between the survivor and non-survivor groups. Initial lactate was significantly raised in nonsurvivors (median 8.7, range 1.9-17.6 mmol/l) compared with survivors (median 2.4, range 0.6-13.6 mmol/l) (p = 0.0002). Twenty one patients (21.1%) with initial lactate concentrations greater than 4.5 mmol/l survived to PICU discharge. Using receiver operating characteristic analysis an initial lactate of 6 mmol/l had the optimum predictive value for mortality. Initial postoperative serum lactate >6 mmol/l predicted mortality with sensitivity 78%, specificity 83%, and positive predictive value of only 32%. Conclusion-Initial lactate concentrations have poor positive predictive value for mortality. The routine measurement of lactate for this purpose cannot be justified in clinical practice.

These results suggest that the LiDCO method can be used to provide safe and accurate measurement of cardiac output in paediatric patients. The method is simple and quick to perform, requiring only arterial and venous catheters, which will already have been inserted for other reasons in these patients.