Clinical profile, etiology, management and outcome of serum sodium disturbances in children admitted in PICU

Abstract

Background: Sodium disorders are common in children who need intensive care, they occur in variety of conditions, may remain unrecognized if not suspected and monitored and result in morbidity and mortality irrespective of primary problem. The aim of the study is to know etiology, management and outcome of sodium disturbances in sick children admitted to pediatric intensive care unit to Institute of Social Pediatrics Stanley Medical College.Methods: This is a hospital based cross sectional study. Two hundred and twenty-seven children in the age group of 1month to 12 years admitted in PICU over the period of 8 months were included in the study. Venous blood sampling is obtained from each patient enrolled in the study and is sent for estimation of electrolytes, blood urea, glucose levels. Serum osmolality (calculated), urine osmolality, urine spot sodium were done in selected patients.Results: Among the 227 children studied, 85 children had sodium disturbances that included both hyponatremia (80 children) and hypernatremia (5 children) The most common cause of hyponatremia is CNS disorder 25 patients (31.25%) followed by poisoning 17.Conclusions: Hyponatremia occurs frequently and should be looked for in all sick children. It is of hypotonic- euvolemic type in almost all the acute infections except diarrhea and should be managed accordingly. They contribute significantly to the mortality and morbidity.

Prevalence and Clinical Significance of Hyponatremia in Pediatric Intensive Care

“…Shock and CNS disorders were associated with the most severe forms of hyponatremia at the PICU. This is in agreement with the study of Jayakumar and Sambasivam 20 who found that about one-third of children with severe hyponatremia were admitted with a CNS disorder. Likewise, Pizzotti et al 23 reported neurological disorders as the main underlying cause of hyponatremia in children.…”

“…In the present study, the prevalence of hyponatremia at PICU admission was 67.2%. This is much greater than earlier reports where it was 44.4% among the children at a Kenyan hospital, 19 35.2% at a PICU in a medical institution in India, 20 29.8% at an Indian pediatric emergency department, 21 and 14.12% at a medical center in Iran. 22 In fact, the difference in prevalence is unexplained, but it may be attributable to the prevalence of underlying etiologies among Saudi children.…”

Challenges of Diagnosing Hyponatremic Syndromes in Pulmonary and Extra Pulmonary Tuberculosis

“…1,2 It is usually mild to moderate, asymptomatic, self-limiting, and reversible with anti-TB therapy 1,2 Hyponatremia is the reduction in serum sodium <135 mmol/L 3,4 and severe hyponatremia occurs when levels are <125 mmol/L. 3 It is one of the commonest electrolyte disturbances 4,5 with prevalence of 1 to 4% in severe forms 1,3 and 15 to 30% in nonsevere forms among hospitalized adults and children. 1,4 Hyponatremia occurs in active TB in 11 to 51% 1,6 of cases and thus its screening is of paramount importance.…”

“…1,4 Hyponatremia occurs in active TB in 11 to 51% 1,6 of cases and thus its screening is of paramount importance. 5 TB causes hyponatremia by affecting the adrenal glands, hypothalamus, pituitary gland, meninges, or lungs through Introduction Pulmonary tuberculosis (PTB) is one of the rare pulmonary infections causing hyponatremia (serum sodium ˂135 mmol/L) and severe hyponatremia (serum sodium ˂125 mmol/L). Although the major cause of hyponatremia in TB patients is syndrome of inappropriate antidiuretic hormone (SIADH) secretion, cerebral salt wasting syndrome (CSWS) can occur and requires evidence of inappropriate urinary salt losses and reduced arterial blood volume.…”