Symptomatic Hyponatremia During Treatment of Dehydrating Diarrheal Disease With Reduced Osmolarity Oral Rehydration Solution

Alam, Nur; Yunus, Mohammed; Faruque, A. S. G.; Gyr, Niklaus; Sattar, Samima; Parvin, Shahanaz; Ahmed, Jamal Uddin; Salam, Mohammed Abdus; Sack, David A.

doi:10.1001/jama.296.5.567

Cited by 42 publications

(14 citation statements)

References 33 publications

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“…In these high-risk patients (see Table 9), it is not clear that cerebral demyelination is completely preventable, as there have been multiple reports of cerebral demyelination occurring with both careful correction or in the absence of hyponatremia [86–96]. Cerebral demyelination has not been reported in children with acute hospital-acquired hyponatremia, nor have neurological complications been associated with the use of 3% NaCl to treat children with acute hyponatremic encephalopathy [97–100]. …”

Section: Who Is At Risk For Developing Cerebral Demyelination?mentioning

confidence: 99%

New aspects in the pathogenesis, prevention, and treatment of hyponatremic encephalopathy in children

2009

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Hyponatremia is the most common electrolyte abnormality encountered in children. In the past decade, new advances have been made in understanding the pathogenesis of hyponatremic encephalopathy and in its prevention and treatment. Recent data have determined that hyponatremia is a more serious condition than previously believed. It is a major comorbidity factor for a variety of illnesses, and subtle neurological findings are common. It has now become apparent that the majority of hospital-acquired hyponatremia in children is iatrogenic and due in large part to the administration of hypotonic fluids to patients with elevated arginine vasopressin levels. Recent prospective studies have demonstrated that administration of 0.9% sodium chloride in maintenance fluids can prevent the development of hyponatremia. Risk factors, such as hypoxia and central nervous system (CNS) involvement, have been identified for the development of hyponatremic encephalopathy, which can lead to neurologic injury at mildly hyponatremic values. It has also become apparent that both children and adult patients are dying from symptomatic hyponatremia due to inadequate therapy. We have proposed the use of intermittent intravenous bolus therapy with 3% sodium chloride, 2 cc/kg with a maximum of 100 cc, to rapidly reverse CNS symptoms and at the same time avoid the possibility of overcorrection of hyponatremia. In this review, we discuss how to recognize patients at risk for inadvertent overcorrection of hyponatremia and what measures should taken to prevent this, including the judicious use of 1-desamino-8d-arginine vasopressin (dDAVP).

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Section: Who Is At Risk For Developing Cerebral Demyelination?mentioning

confidence: 99%

New aspects in the pathogenesis, prevention, and treatment of hyponatremic encephalopathy in children

2009

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“…In children with acute hyponatremic encephalopathy, 12 ml/kg body weight of 3% NaCl infused over 4 h has been used without apparent neurological sequelae. 69,70 Much of the change in serum sodium level is a function of the renal response to therapy, making formulae unreliable for predicting the change in serum sodium.…”

Section: Treatment Of Hyponatremic Encephalopathymentioning

confidence: 99%

Hospital-acquired hyponatremia—why are hypotonic parenteral fluids still being used?

2007

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Hospital-acquired hyponatremia can be lethal. There have been multiple reports of death or permanent neurological impairment in both children and adults. The main factor contributing to the development of hospital-acquired hyponatremia is routine use of hypotonic fluids in patients in whom the excretion of free water, which is retained in response to excess arginine vasopressin (AVP), might be impaired. The practice of administering hypotonic parental fluids was established over 50 years ago, before recognition of the fact that there are numerous potential stimuli for AVP production in most hospitalized patients. Virtually all neurological morbidity resulting from hospital-acquired hyponatremia has been associated with administration of hypotonic fluids. Multiple prospective studies have shown that 0.9% NaCl is effective prophylaxis against hyponatremia. There is not a single report in the literature of neurological complications resulting from the use of 0.9% NaCl in non-neurosurgical patients. Patients at greatest risk of developing hyponatremic encephalopathy following hypotonic fluid administration are children, premenopausal females, postoperative patients, and those with brain injury or infection, pulmonary disease or hypoxemia. When hyponatremic encephalopathy develops, immediate administration of 3% NaCl is essential. In this Review, we discuss the question of why administering hypotonic fluids is unphysiologic and potentially dangerous, the settings in which isotonic fluids should be administered to prevent hyponatremia, and the appropriate treatment of hyponatremic encephalopathy.

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“…The current WHO solution is somewhat hypotonic, and the literature suggests that hypotonicity really does not matter for severe diarrheal disease. 72 Studies also suggest that the addition of glucose will aid in the delivery of water. 73 The ideal solution and the best mode of delivery are currently not known (Table 2 and 3).…”

Section: Oral Resuscitationmentioning

confidence: 99%

Burn Resuscitation

Greenhalgh

2007

Journal of Burn Care & Research

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Symptomatic Hyponatremia During Treatment of Dehydrating Diarrheal Disease With Reduced Osmolarity Oral Rehydration Solution

Abstract: The risk of symptoms associated with hyponatremia in patients treated with the reduced osmolarity ORS is minimal and did not increase with the change in formulation.

Cited by 42 publications

References 33 publications

New aspects in the pathogenesis, prevention, and treatment of hyponatremic encephalopathy in children

New aspects in the pathogenesis, prevention, and treatment of hyponatremic encephalopathy in children

Hospital-acquired hyponatremia—why are hypotonic parenteral fluids still being used?

Burn Resuscitation

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