Incidence of hyponatraemia and hyponatraemic seizures in severe respiratory syncytial virus bronchiolitis

Abstract

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.

Identification and Characterization of an Activating F229V Substitution in the V2 Vasopressin Receptor in an Infant with NSIAD

“…Despite the low level of circulating AVP, the patient was diagnosed with SIADH secondary to bronchiolitis. 7 At 6 months, the patient had a second apneic episode, but no laboratory tests were performed. A third apneic episode occurred at 9 months of age, prompting a second hospitalization with additional laboratory evidences of euvolemic hyponatremia (plasma renin activity ,20 ng/dl per hour) and again undetectable vasopressin level ( Table 1).…”

Potenciales consecuencias neurocognitivas de infección por virus respiratorio sincicial humano

“…Durante la última década se han reportado diversas manifestaciones extra-pulmonares asociadas a la infección por VRS, entre las cuales están alteraciones hepáticas 22,23 , renales 24 , endocrinas 22,25 , cardiovasculares 26,28 y del sistema nervioso central (SNC) 22,[29][30][31] . El compromiso de estos dos últimos sistemas podría explicar la asociación del virus con muerte súbita en lactantes menores 22,26 .…”

Manutenção parenteral de líquidos na criança agudamente doente

“…[19][20][21] The incidence of hospital-acquired hyponatremia has been reported to be as high as 50% in some instances. 22,23 What is of concern is that these reports identify previously healthy and not necessarily critically ill patients, who are at highest risk. [29][30][31] The risk of hyponatremia and adverse neurological sequelae in these patients is seldom recognized or anticipated 12,29,30 , and is thus compounded by the administration of hypotonic solutions, and minimal biochemical and fluid monitoring.…”

“…The traditional recommendations for EFW requirements will lead to an overestimation, particularly in critically ill, mechanically ventilated patients, and hence there is a rationale for reducing standard maintenance fluid rates by up to 40-50% in some instances, provided the patient is not hypovolemic. 22,32,34,41 …”