Hyponatremia in children with acute respiratory infections: A reappraisal

Abstract

Hyponatremia (<135 mmol/L), typically associated with an elevated anti-diuretic hormone level, is common among children admitted with bronchiolitis, pneumonia, or pulmonary exacerbation of cystic fibrosis. The main consequences of acute hyponatremia include cerebral edema and Ayus-Arieff pulmonary edema. A widespread belief is that, in children with pneumonia or bronchiolitis, hyponatremia results from inappropriate anti-diuresis. By contrast, the pathogenic role of extracellular fluid volume depletion or decreased effective circulating blood volume is underscored. Considering the prevalence of hyponatremia, sodium determination is advised on admission in children diagnosed with bronchiolitis, pneumonia, or pulmonary exacerbation of cystic fibrosis. There is no necessity to do anything beyond reassessing the appropriateness of fluid therapy in cases with mild (130-134 mmol/L) hyponatremia. In children with sodium <130 mmol/L, the underlying etiology is sometimes evident from history and physical findings. Given that clinical assessment of fluid volume status is difficult in hyponatremia, further laboratory evaluation is often required in these patients. An increase in sodium level ≤6 mmol/L per day is currently considered the therapeutic goal in all cases. Emergency correction with a 2 mL/kg body weight bolus of 3.0% saline over 10-15 min intravenously is advised in cases with severe symptoms due to hyponatremia and in cases with symptoms, even if mild, due to a rapid-onset (<48 h) of hyponatremia (two additional doses are administered if the patient's condition does not improve).

Electrolyte and Acid-Base Abnormalities in Infants with Community-Acquired Acute Pyelonephritis: Prospective Cross-Sectional Study

“…In hyponatremic patients, fever, poor feeding, frequent regurgitations, and loose stools were rather common, pointing out a volume-dependent antidiuresis. Unsurprisingly, therefore, current tenet is that in most febrile diseases associated with hyponatremia, the latter is generally volume-dependent [12][13][14] .…”

Hyponatremia: Causes, Clinical Manifestations and Correction

“…Îñîáëèâî ó íåìîâëÿò, îðãàí³÷í³ îñìîë³, ÿê³ àäàïòóþòü êë³òèíó äî õðîí³÷íî¿ ã³ïåðíàòð³å쳿, äóaeå ïîâ³ëüíî âòðà÷àþòüñÿ êë³òèíàìè ïðè íîðìà-ë³çàö³¿ îñìîëÿðíîñò³ ³íòåðñòèö³þ. Ñàìå òîìó, øâèäêà ðåã³äðàòàö³ÿ, ÿêà ïðèçâîäèòü äî øâèäêî¿ êîðåêö³¿ õðîí³÷íî¿ ã³ïåðíàòð³å쳿, âèêëèêຠâ íèõ ñóäîìè òà âèïóêë³ñòü âåëèêîãî äaeåðåëüöÿ (ïðîÿâè íàáðÿêó ìîçêó) [32,33].…”

Hiponatremia em uma Unidade de Terapia Intensiva Pediátrica

“…Neste estudo, 35,2% (n=211) dos pacientes tinham doença respiratória. É reconhecido que crianças e adolescentes com bronquiolite, pneumonia e exacerbação do comprometimento pulmonar na fibrose cística 43,45 são vulneráveis à hiponatremia durante as internações hospitalares. Hanna et al 46 registraram a incidência de 33% de pacientes transferidos à UTI com bronquiolite.…”

“…Neste estudo, escore de gravidade (PRISM), o maior tempo de internação e de ventilação mecânica observados na hiponatremia, denotam a complexidade clínica, destes pacientes na utilização de recursos hospitalares. Pacientes com encefalopatia hiponatrêmica podem desenvolver edema pulmonar neurogênico (Síndrome de Ayus-Arieff) 45 que acarreta agravamento do quadro neurológico e respiratório da doença de base, contribuindo para maior tempo de internação e de ventilação mecânica 30,53 .…”

“…Pacientes com hiponatremia tiveram tempo médio mais prolongado de internação (14,1 dias; DP=43,1 versus 5,1 dias; DP=6,1; p<0,000) e de ventilação mecânica (7,3 dias; DP=39,9 versus 1,7 dias; DP=3,5; p<0,000), maior gravidade (PRISM=9,1; DP=7,1 versus 6,6; DP=6,2; p< 0,000) e mortalidade (n=90; 8,5% versus n=24; 3%; p<0,000). ( 12,4) 126 (15,9) 257 (13,9) Procedência; n (%) 0,099* Domiciliar 482 (45,7) 392 (49,6) 874 (47,3) Hospitalar 573 (54,3) 399 (50,4) 972 (52,7) Doenças; n (%) 0,541* Aguda 301 (28,5) 236 (29,8) 537 (29,1) Crônica 754 (71,5) 555 (70,2) 1309 (70,9) Doenças crônicas; n (%) 0,000* Não Complexa 112 (14,9) 124 (22,3) 236 (18,2) Complexa 642 (85,1) 431 (77,7) 1073 (82,2) Diagnóstico Clínico; n (%) Falência Respiratória 211 (35,2) 152 (39,6) 363 (37,0) Sepse / Choque séptico 137 (22,9) 49 (12,8) 186 (18,9) Disfunções Neurológicas 95 (15,9) 81 (21,1) 176 (17,9) ICC / Choque cardiogênico 39 (6,5) 29 (7,6) 68 (6,9) Distúrbio HE-AB 31 …”