Hyponatraemia in a Lao paediatric intensive care unit: Prevalence, associations and intravenous fluid use

Abstract

Aim Hyponatraemia is a common and potentially deadly complication affecting hospitalised children world‐wide. Hypotonic intravenous fluids can be a significant exacerbating factor. Exclusive use of isotonic fluids, coupled with rigorous blood monitoring, has proven effective in reducing hyponatraemia in developed settings. In developing countries, where hyponatraemia is often more common and severe, different factors may contribute to its incidence and detection. We aimed to determine the prevalence and disease associations of hyponatraemia and describe the intravenous maintenance fluid prescribing practices in a Lao paediatric intensive care unit. Methods We conducted a cross‐sectional study of 164 children aged 1 month to 15 years admitted to intensive care at a tertiary centre in Lao People's Democratic Republic (PDR) and recorded their serum sodium and clinical data at admission and on two subsequent days. Results Hyponatraemia was detected in 41% (67/164, confidence interval 34–48%) of children, the majority of which was mild (34%, 56/164) and present at admission (35%, 55/158). Hyponatraemia was more common in malnourished children (odds ratio (OR) 2.3, P = 0.012) and females (OR 1.9, P = 0.045). Hyponatraemia correlated with death or expected death after discharge (OR 2.2, P = 0.015); 88% received maintenance intravenous fluids, with 67% of those receiving a hypotonic solution. Electrolyte testing was only performed in 20% (9/46) of patients outside the study protocol. Conclusions Hyponatraemia is highly prevalent in critically ill children in Lao PDR, as is the continued use of hypotonic intravenous fluids. With financial and practical barriers to safely detecting and monitoring electrolyte disorders in this setting, this local audit can help promote testing and has already encouraged changes to fluid prescribing.

Early Plasma Osmolality Levels and Clinical Outcomes in Children Admitted to the Pediatric Intensive Care Unit: A Single-Center Cohort Study

“…Decreased osmolality indicates an increase in water or a decrease in solutes in the body, which is often observed in heart failure, hypoproteinemia, hyponatremia, the oliguric phase of renal failure, and hypotonic dehydration. An imbalance in plasma osmolality is very common in critically ill patients ( 19 – 21 ). In this study, more than half (55.98%) of the patients showed abnormal osmolality.…”

Evaluating fluid overload in critically ill children

“…Second, overzealous fluid administration, and in particular with hypotonic solutions, during low urine output increases the risk for hyponatremia [28][29][30]. This is the most common electrolyte disturbance in the PICU setting, with reported prevalences up to 24-67% [29,31].…”

“…Second, overzealous fluid administration, and in particular with hypotonic solutions, during low urine output increases the risk for hyponatremia [28][29][30]. This is the most common electrolyte disturbance in the PICU setting, with reported prevalences up to 24-67% [29,31]. An inappropriate secretion of antidiuretic hormone (SIADH), which can be triggered by multiple factors including (respiratory) infections, inflammation, neurological disorders and mechanical ventilation, leading to excess free water is believed to contribute frequently to the observed hyponatremia and edema formation in PICU patients, but the exact underlying mechanisms and prevalence remain unclear [32,33].…”

Hyponatremia in Children with Systemic Inflammatory Response Syndrome Presenting to the Emergency Department

“…Hyponatremia is the most common disorder of electrolytes encountered in clinical practice and is highly prevalent in critically ill children [1][2][3]. Variable degrees of hyponatremia occur in up to 30% of hospitalized patients [4,5].…”