Hyponatremia in pediatric community-acquired pneumonia

Abstract

Studies focusing on serum sodium disorders in children with community-acquired-pneumonia (CAP) are nearly entirely lacking, though clinical experience suggests that at least hyponatremia (HN) might be rather common. We evaluated the incidence of hypo- and hypernatremia, in relation to other clinical, laboratory and etiological findings, in pediatric CAP. Serum sodium concentration was measured in 108 ambulatory and hospitalized children with radiologically confirmed CAP of variable severity. The etiology of CAP was revealed by serology in 97 patients. HN (serum sodium < 135 mmol/l) was present in 49 (45.4%) children, and it was mild (> 130 mmol/l) in 92% of the cases. On admission, hyponatremic patients had higher body temperature (38.96 degrees C vs 38.45 degrees C, P = 0.008), white blood cell count (21,074/microl vs 16,592/microl, P = 0.008), neutrophil percentage (78.93% vs 69.33%, P = 0.0001), serum C-reactive protein (168.27 mg/l vs 104.75 mg/l, P = 0.014), and serum procalcitonin (22.35 ng/ml vs 6.87 ng/ml, P = 0.0001), and lower calculated osmolality (263.39 mosmol/l vs 272.84 mosmol/l, P = 0.0001) than normonatremic ones. No association was found with plasma glucose, type of radiological consolidation or etiology of CAP. HN is common but usually mild in children with CAP. HN seems to be associated with the severity of CAP, assessed by fever, need of hospitalization and serum non-specific inflammatory markers.

Hyponatremia in Children Requiring Hospitalization

“…The proportion of cases with hyponatremia across various diagnostic categories ranged from 3 to 20%. In a recent study by Don M et al, hyponatremia was found in 45.4% of children with community acquired pneumonia [5] incidence of which was similar to present study. 46.5% children with pneumonia had hyponatremia in our study.…”

Hyponatremia in children with respiratory tract infection

“…We read with great interest the article entitled "Hyponatremia in pediatric community-acquired pneumonia" by Don et al in the latest issue of this journal [1], and we congratulate their elegant study.…”

“…There have been several reports regarding HN in children with pneumonia [1][2][3][4], including the study by Don et al In those studies the authors speculated that the mechanism of HN in pneumonia is due to the syndrome of inappropriate antidiuretic hormone (ADH) secretion and found that HN was associated with the severity in pneumonia. In addition, we here would like to suggest that the deeper the site of inflammation in the respiratory tract, the higher the prevalence of HN in children with RTIs.…”

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Sirs,We read with great interest the article entitled "Hyponatremia in pediatric community-acquired pneumonia" by Don et al in the latest issue of this journal [1], and we congratulate their elegant study.They concluded that hyponatremia (HN) is common (present in 45.4% of children with community-acquired pneumonia) and seems to be associated with the severity, assessed by fever, need of hospitalization and serum nonspecific inflammatory markers.We would like to add a comment based on our retrospective analysis. In 2004 we encountered serial patients with HN who had ben admitted to our hospital because of respiratory tract infection (RTI).

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Impact of hyponatremia and the syndrome of inappropriate antidiuresis on mortality in elderly patients with aspiration pneumonia

“…2 Previous studies have suggested that the presence and degree of hyponatremia is associated with the severity of pneumonia in adults and children, although the results have differed among studies. [3][4][5][6][7] Hyponatremia is caused by various factors, including volume depletion, use of diuretics, hypothyroidism, adrenal insufficiency, heart failure, renal failure, and cirrhosis. Additionally, the syndrome of inappropriate antidiuresis (SIAD) is a frequent and heterogeneous disorder characterized by hyponatremia and impaired urinary dilution in the absence of any recognized stimulation of antidiuretic hormone secretion.…”