Les hyponatrémies postopératoires de l’enfant : physiopathologie, diagnostic et traitement

Brouh, Y.; Paut, O.; Tsimaratos, Michel; Camboulives, J

doi:10.1016/j.annfar.2003.09.009

Cited by 20 publications

(6 citation statements)

References 56 publications

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“…This is in direct contrast to the treatment of inappropriate antidiuresis, the crux of which is free water restriction [4][5][6][7][8][9]19].…”

Section: Managementmentioning

confidence: 99%

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Renal salt-wasting syndrome in children with intracranial disorders

Bettinelli¹,

Longoni²,

Tammaro³

et al. 2012

Pediatr Nephrol

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Hypotonic hyponatremia, a serious and recognized complication of any intracranial disorder, results from extra-cellular fluid volume depletion, inappropriate anti-diuresis or renal salt-wasting. The putative mechanisms by which intracranial disorders might lead to renal salt-wasting are either a disrupted neural input to the kidney or the elaboration of a circulating natriuretic factor. The key to diagnosis of renal salt-wasting lies in the assessment of extra-cellular volume status: the central venous pressure is currently considered the yardstick for measuring fluid volume status in subjects with intracranial disorders and hyponatremia. Approximately 110 cases have been reported so far in subjects ≤18 years of age (male: 63%; female: 37%): intracranial surgery, meningo-encephalitis (most frequently tuberculous) or head injury were the most common underlying disorders. Volume and sodium repletion are the goals of treatment, and this can be performed using some combination of isotonic saline, hypertonic saline, and mineralocorticoids (fludrocortisone). It is worthy of a mention, however, that some authorities contend that cerebral salt wasting syndrome does not exist, since this diagnosis requires evidence of a reduced arterial blood volume, a concept but not a measurable variable.

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“…This is in direct contrast to the treatment of inappropriate antidiuresis, the crux of which is free water restriction [4][5][6][7][8][9]19].…”

Section: Managementmentioning

confidence: 99%

“…Since in renal salt-wasting the renal concentrating ability is preserved and the vasopressin level high, the concentration of sodium in the urine may rise to close to 300 mmol/L; hence, a patient given a large amount of normal saline (Na + 155 mmol/L) may sometimes further decrease the blood level of sodium [4][5][6][7][8][9]19].…”

Section: Managementmentioning

confidence: 99%

Renal salt-wasting syndrome in children with intracranial disorders

Bettinelli¹,

Longoni²,

Tammaro³

et al. 2012

Pediatr Nephrol

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“…Este fenómeno se describió inicialmente en el postoperatorio de cirugías ginecológicas, pero puede ocurrir en cualquier situación en que exista una actividad aumentada de aDH. Su manejo consiste en disminuir el aporte de sodio [24][25][26][27][28] .…”

Section: Fenómeno De Desalinaciónunclassified

Bases fisiopatológicas de los trastornos del sodio en pediatría

2014

Rev. chil. pediatr.

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Dysnatremia is among the most common electrolyte disorders in clinical medicine and its improper management can have serious consequences associated with increased morbidity and mortality of patients. The aim of this study is to update the pathophysiology of dysnatremia and review some simple clinical and laboratory tools, easy to interpret, that allow us to make a quick and simple approach. Dysnatremia involves water balance disorders. Water balance is directly related to osmoregulation. There are mechanisms to maintain plasma osmolality control; which are triggered by 1-2% changes. Hypothalamic osmoreceptors detect changes in plasma osmolality, regulating the secretion of Antidiuretic Hormone (ADH), which travels to the kidneys resulting in more water being reabsorbed into the blood; therefore, the kidney is the main regulator of water balance. When a patient is suffering dysnatremia, it is important to assess how his ADH-renal axis is working. There are causes of this condition easy to identify, however, to differentiate a syndrome of inappropriate ADH secretion from cerebral salt-wasting syndrome is often more difficult. In the case of hypernatremia, to suspect insipidus diabetes and to differentiate its either central or nephrogenic origin is essential for its management. In conclusion, dysnatremia management requires pathophysiologic knowledge of its development in order to make an accurate diagnosis and appropriate treatment, avoiding errors that may endanger the health of our patients.

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“…Several studies showed that in the postoperative period, children are more subject to plasma electrolyte changes 2,4–6 . This can be explained by the loss or dysfunction of homeostatic mechanisms during the postoperative period but also by the multiple therapeutic interventions potentially iatrogenic.…”

mentioning

confidence: 99%

“…Several studies showed that in the postoperative period, children are more subject to plasma electrolyte changes. 2 , 4 – 6 This can be explained by the loss or dysfunction of homeostatic mechanisms during the postoperative period but also by the multiple therapeutic interventions potentially iatrogenic. Neurosurgery and cardiac surgery are known to cause dysnatremia; 7 , 8 only 3 cases have been reported after cleft lip or palate repair and in 2 cases after palatoplasty.…”

mentioning

confidence: 99%

Postoperative Dysnatremia in Pediatric Patients Undergoing Palatoplasty

Lonfat

Scala

2023

Journal of Craniofacial Surgery

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Identifying predisposing factors to dysnatremia to improve perioperative care after cleft surgery. Design: Retrospective case series. Patient data were obtained through the electronic medical records of the hospital. Setting: Tertiary care university hospital. Patients: The inclusion criterion was the measurement of an abnormal natremia value, defined as Na > 150 or <130 mmol/l after a cleft lip or cleft palate repair procedure. The exclusion criterion was natremia between 131 and 149 mmol/l. Results: Natremia measurements were available for 215 patients born between 1995 and 2018. Five patients presented with postoperative dysnatremia. Several predisposing factors to dysnatremia have been identified: drugs, infection, administration of intravenous fluids, and postoperative syndrome of inappropriate antidiuretic hormone secretion. Although the hospital environment contributes to dysnatremia development, the fact that only patients undergoing cleft palate repair develop natremia anomalies suggests that this surgery may be itself a risk factor. Conclusion: Children undergoing palatoplasty may be at higher risk to develop postoperative dysnatremia. Early recognition of symptoms and risk factors, postoperative monitoring, and prompt treatment of dysnatremia diminish the risk of neurological complications.

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Les hyponatrémies postopératoires de l’enfant : physiopathologie, diagnostic et traitement

Cited by 20 publications

References 56 publications

Renal salt-wasting syndrome in children with intracranial disorders

Renal salt-wasting syndrome in children with intracranial disorders

Bases fisiopatológicas de los trastornos del sodio en pediatría

Postoperative Dysnatremia in Pediatric Patients Undergoing Palatoplasty

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