Nonosmotic secretion of arginine vasopressin and salt loss in hyponatremia in Kawasaki disease

Abstract

Background The precise mechanism of hyponatremia in Kawasaki disease (KD) remains elusive because assessment of volume status based on serial changes in body weight is lacking in previous reports. Methods Seventeen patients who were diagnosed with KD and hyponatremia (serum sodium levels <135 mmol/L) were analyzed. Volume status was assessed based on serial changes in body weight. Plasma arginine vasopressin (ADH), urine electrolytes, and serum cytokine levels were measured on diagnosis of hyponatremia. An increase in body weight by >3% was defined as hypervolemia and a decrease in body weight by >3% was defined as hypovolemia. Results The volume status was hypervolemic in three patients (18%), euvolemic in 14 (82%), and hypovolemic in none (0%). Five (29%) patients were diagnosed with “syndrome of inappropriate secretion of antidiuretic hormone” (SIADH) and no patients were diagnosed with hypotonic dehydration. The contribution of decreased total exchangeable cations (salt loss) to hyponatremia (5.9% [interquartile range, 4.3%, 6.7%]) was significantly larger than that of increased total body water (−0.7% [−1.8%, 3.1%]) (P = 0.004). Serum interleukin‐6 levels were elevated in all of the nine patients who were evaluated. Among the 12 (71%) patients who did not meet the criteria of SIADH and hypotonic dehydration, plasma ADH levels were inappropriately high in ten patients. These patients were also characterized by euvolemic or hypervolemic hyponatremia and salt loss, which might be compatible with a diagnosis of SIADH. Conclusions Our study shows that hyponatremia in KD is euvolemic or hypervolemic and is associated with nonosmotic secretion of ADH and salt loss in the majority of patients.

Significance of hyponatremia in Kawasaki disease

“…In this issue of the Journal, Miura et al showed that, in most Kawasaki disease patients, hypotonic dehydration was unlikely to be a cause of hyponatremia. And they report that hyponatremia in KD is euvolemic or hypervolemic and is associated with nonosmotic secretion of ADH and salt loss in the majority of patients . From their reports, it is considered that large amounts of fluid replacement are not necessary for correction of hyponatremia in KD.…”

Sodium-containing versus sodium-trace preparations of IVIG for children with Kawasaki disease in the acute phase

“…Hyponatremia can be experienced in a variety of in ammatory diseases [15]. KD patients in the acute phase frequently have hyponatremia [16][17][18][19]. A national survey on KD in Japan showed that almost 60% patients had serum Na levels below 134 mEq/mL [20].…”

Incidence and Severity of Community- and Hospital-Acquired Hyponatremia in Pediatrics

“…There are limited studies on the overall incidence of hyponatremia in children, with wide variation in the reported incidence rates in hospitalized children. The heterogeneity in the scientific literature is due to some factors, such as cut-off values of plasma sodium level [6], scope of patient care (general ward or intensive care) [1], process of hospitalization (emergency, elective, medical, or surgical) [7,8], and studies limited to specific clinical pathologies, such as gastroenteritis [9], bronchiolitis [9], pneumonia [10], meningitis [11], pyelonephritis [9], and others [12,13]. Therefore, it is difficult to validate the incidence of hyponatremia in hospitalized children on a general pediatric ward from published data.…”