Hyponatraemia and the inappropriate ADH syndrome in pneumonia

Abstract

We studied serum sodium, plasma osmolality and urinary sodium and osmolality on days 1, 3 and 5 of hospitalization of 100 children aged from 1 month to 12 years admitted with a diagnosis of pneumonia. Hyponatraemia (serum sodium concentration < or = 130 mmol/l) was found in 31 patients at the time of admission. The probable cause of hyponatraemia in 94% of cases was the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Symptoms and signs indicative of severe pneumonia were two to three times more frequent and the mean duration of tachypnoea, chest-wall retraction and hospital stay about one and a half times longer in children with hyponatraemia. Four children died (two on day 1, one on day 5 and one on day 8); all four had a serum sodium concentration < or = 125 mmol/l which persisted until death. Of the remaining 27 hyponatraemic children, serum sodium concentrations returned to normal on day 3 in 26, while in one hyponatraemia persisted until day 7. The recovery from hyponatraemia showed a good correlation with improvement in clinical signs of respiratory distress. The SIADH occurred in about one-third of the children hospitalized for pneumonia, and was associated with a more severe disease and a poorer outcome. Perhaps fluid restriction in these cases may improve the outcome.

Hyponatremia in children with respiratory tract infection

“…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.…”

Complicated pneumonia in children

“…It occurs in around one-third of children hospitalised with CAP [26], the mechanism for which remains unclear, and is associated with higher inflammatory markers [27] and poorer outcomes [26]. Severe hyponatraemia can cause confusion or seizures and for this reason fluid restriction (between 50% and 66% of maintenance) is recommended in children with CAP and hyponatraemia who are haemodynamically stable and not dehydrated [28].…”

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

“…9 One study has shown an association between the severity of pneumonia in children and the development of hyponatremia due to SIAD. 10 To our knowledge, there have been no studies evaluating the impact of different causes of hyponatremia on mortality in elderly patients with aspiration pneumonia.…”