This article is part of the supplement: 22nd International Symposium on Intensive Care and Emergency Medicine

Meeting abstract

Acute in-hospital hyponatremia in children: an observational study

EJ Hoorn1,5, M Robb2, D Geary3, ML Halperin4, E van der Voort5 and D Bohn1

Author Affiliations

1 Department of Critical Care Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada

2 Department of Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada

3 Department of Nephrology, The Hospital for Sick Children, University of Toronto, Toronto, Canada

4 Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Canada

5 Department of Pediatric Intensive Care, Sophia Children's Hospital, Erasmus University Rotterdam, Rotterdam, The Netherlands

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Critical Care 2002, 6(Suppl 1):P168 doi:10.1186/cc1627


The electronic version of this article is the complete one and can be found online at:


Published:1 March 2002

©

Introduction

To develop hyponatremia (plasma sodium concentration (PNa) < 136 mM), there must be a source of electrolyte free water (EFW) and actions of antidiuretic hormone (ADH) to prevent its excretion. A low PNa is the most common electrolyte disorder in hospitalized children and it makes them more prone to neurological damage.

Objectives

To establish the incidence of and to identify risk factors for the development of hospital-acquired hyponatremia in a tertiary care hospital.

Methods

We included all children (n = 432) who had two or more PNa-measurements in the Emergency Department in a 3-month period and in hospital over the first 48 hours.

Results

The incidence of hyponatremia was 22.5% of whom 14.4% were hyponatremic on presentation and 9.3% developed hyponatremia in hospital (five patients fell in both groups). ADH was likely elevated due to disease (7.9%; e.g. bronchiolitis), symptoms (47%; e.g. nausea) and treatment (45.1%; e.g. surgery). Eighty-three percent of the EFW responsible for the falls in PNa was administered as either hypotonic intravenous (66%) or oral fluids (34%) and was excessive in 53% of the cases. Those who did not seem to receive excessive EFW had an occult source of water, hyperglycemia (16%), mannitol (8%) and/or excreted hypertonic urine (62%).

Conclusions

The most important factor for hospital-acquired hyponatremia is the administration of hypotonic fluids. Hospital-acquired hyponatremia is iatrogenic and therefore preventable. It unnecessarily puts children at risk of neurological damage. The practice of IV-fluid therapy should be re-evaluated.

References

  1. Halberthal M, Halperin ML, Bohn D: Acute hyponatraemia in children admitted to hospital :retrospective analysis of factors contributing to its development and resolution.

    BMJ 2001, 322:780-782. PubMed Abstract | Publisher Full Text OpenURL