Children with mild hyponatremia at the emergency department are at higher risk of more severe infections and hospitalization.

Abstract

Background Mild hyponatremia is frequently encountered in the pediatric emergency department (PED). Although it is usually of little clinical concern, its prognostic meaning as a possible marker of more severe disease is not well established. Methods We retrospectively analyzed data from children and adolescents who performed a blood sample with plasmatic sodium measurement on admission to PED of IRCCS "Burlo Garofolo" Pediatric Hospital in Trieste, Italy, in 2019. We compared the clinical and laboratory characteristics of patients with hyponatremia to those with normal sodium. Results Among 807 subjects, hyponatremia (sodium < 135 mEq/L) was present in 17.6%, being mild (134 − 130 mEq/L) in 16.5%. Hyponatremic patients were younger, more frequently males, with an infection diagnosis, mainly of the respiratory tract and of viral aetiology. They presented higher C-reactive protein (CRP) levels and erythrocyte sedimentation rates (ESR). Compared to normonatremic individuals, hyponatremic patients presented a higher risk of an underlying infection (aOR 2.02; 95%CI 1.33–3.08), higher risk of hospital admission (aOR 1.72; 95%CI 1.06–2.48), and a longer hospital stay (aOR 1.99; 95%CI 1.03–3.85). When considering only subjects with mild hyponatremia, we found similar results. Conclusion Hyponatremia and mild hyponatremia in the PED are associated with an increased admission rate and longer hospital stay. Mild hyponatremia should be considered a warning sign for a possibly more relevant condition.

Updates in hyponatremia and hypernatremia

“…Sodium is the major cation in the extracellular fluid and is the main determinant of plasma osmolality, which is estimated according to the following equation (7): ]. In the pediatric population, hyponatremia is one of the most common electrolyte abnormalities, with a reported incidence of 17.6% of children presenting to the emergency department [10], 9.3% of hospitalized children [11], and 67.2% of patients admitted to the pediatric intensive care unit [12].…”

“…Hyponatremia is classified into mild (130–134 mmol/l), moderate (125–129 mmol/l), and severe (<125 mmol/l) [9 ▪▪ ]. In the pediatric population, hyponatremia is one of the most common electrolyte abnormalities, with a reported incidence of 17.6% of children presenting to the emergency department [10], 9.3% of hospitalized children [11], and 67.2% of patients admitted to the pediatric intensive care unit [12].…”

The predictive value of plasma sodium and other laboratory parameters in determining complicating appendicitis in children

“…Serum sodium level affects the cellular volume and determines tonicity, thus regulating uid distribution among different body compartments (34). Hyponatremia is the most common electrolyte abnormality encountered in hospitalized patients, either as a complication of an underlying acute illness or as a consequence of therapeutic interventions (35).…”