Twenty-Four-Hour Urinary Sodium Excretion Predicts Therapeutic Effectiveness of Oral Rehydration Saline in Pediatric Vasovagal Syncope

Abstract

The study was designed to explore whether 24-hour urinary sodium excretion could predict the therapeutic effectiveness of oral rehydration saline in pediatric cases of vasovagal syncope. Eighty children suffering from vasovagal syncope with oral rehydration saline treatment in Department of Pediatrics, Peking University First Hospital, China, were recruited into the study. They were followed up for 3 (2, 3) months after treatment. Pre-treatment demographic, clinical, head-up tilt test-based hemodynamic and laboratory variables were compared between responders and non-responders. After univariate analysis, variables with p value < 0.05 in the comparison between responders and non-responders were further analyzed by binary logistic regression analysis. Receiver operating characteristic (ROC) curve was conducted to assess the value in predicting effectiveness of oral rehydration saline treatment. The results showed that 33 cases were responders, and 47 were non-responders. Blood sodium (138 ± 2 mmol/L vs. 139 ± 2 mmol/L, p < 0.05) and pre-treatment 24-hour urinary sodium excretion (74 ± 29 mmol/24 h vs. 109 (93, 141) mmol/24 h, p < 0.001) were lower in responders than in non-responders. The baseline 24-hour urinary sodium excretion was positively correlated to the duration from tilting to the positive response appearance in head-up tilt test (r = 0.289, p < 0.01). The cut-off value of baseline 24-hour urinary sodium excretion of the therapeutic effectiveness of oral rehydration saline on vasovagal syncope cases was 83 mmol/24 h, yielding a sensitivity of 87% and a specificity of 73% with AUC of 0.842 (p < 0.001). In conclusion, 24-hour urinary sodium excretion could be a useful biomarker to predict the therapeutic response to oral rehydration saline in pediatric cases of vasovagal syncope.

Predicting therapeutic efficacy of oral rehydration salts in children with vasovagal syncope

“…Therefore, there is a strong need to find out useful markers to indicate the VVS patients with hypovolemia as the main pathogenesis to guide the ORS therapy. It has been noted that BMI and 24-hour sodium excretion collection have correlation with blood volume ( 27 ) and were used to predict the effectiveness of ORS therapy for children with VVS ( 19 , 20 ). However, as an indirect correlative factor to blood volume, BMI may be influenced by the genetic factors as well as the content of body fat, which may challenge the value of BMI in predicting the effectiveness of fluid and salt supplementation.…”

“…Therefore, to increase the effectiveness of ORS on VVS patients, it is extremely necessary to find out some stable and easy-to-perform predictors or develop practical predictive models to indicate those VVS children with hypovolemia as the main pathogenesis to select ORS as the clinical therapeutic options. Previously, body mass index (BMI) ( 19 ) or 24-hour urinary sodium excretion ( 20 ) were utilized to predict the effectiveness of ORS in patients with VVS. Although both can indirectly reflect blood volume, the predictive value of a single indicator is always limited and has its own limitations.…”

Markers for predicting the efficacy of beta-blockers in vasovagal syncope management in children: A mini-review

“…The pathophysiology of VVS is very complex, involving a variety of potential mechanisms, such as hypercatecholamine and hypersympathetic nerve function, excessive vasorelexation or relatively low blood volume, etc (7)(8)(9). and the pathophysiology varies greatly among VVS individuals.…”

Cardiovascular Disease in Children: The Future Is Now

“…In this Special Issue, dedicated to "Cardiovascular Disease in Children", we are covering some of these aspects. From middle-term outcomes after anatomical surgery [7]; through application of percutaneous interventional techniques in rare paediatric syndromes [8]; vasovagal syncope [9]; the role of neonatal therapeutic hypothermia on QTc interval prolongation [10]; to echocardiography applications and perspectives [11,12]; inflammatory conditions such as Kawasaki disease in young infants and children [13] and multisystem inflammatory syndrome [12,14]; prevalence variations in arterial hypertension around the COVID-19 pandemic [15]; up to the exciting field of vascular health and cardiovascular biomarkers [16,17], we are inviting you on an inspiring journey.…”