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Sodium and water homeostasis in children with shigellosis
1Department of Pediatrics, Huddinge University Hospital, Stockholm, Sweden. hans.lindblad@klinvet.ki.se
Insights
Shigellosis in children can cause hyponatremia (low serum sodium), linked to higher mortality. This study found altered hormone levels and stool sodium losses contribute to hyponatremia in shigellosis patients.
Area of Science:
- Pediatric Infectious Diseases
- Renal Physiology
- Endocrinology
Background:
- Shigellosis is associated with higher mortality in hyponatremic children in Bangladesh.
- Hyponatremia (serum sodium < 130 mmol/L) is a critical concern in pediatric shigellosis.
- Understanding the impact on renal hemodynamics and homeostasis is vital for management.
Purpose of the Study:
- To investigate the effects of Shigella dysenteriae type I infection on renal hemodynamics.
- To analyze sodium and water homeostasis in hyponatremic (HN) versus normonatremic (NN) children before treatment.
- To explore the roles of plasma renin, aldosterone, and anti-diuretic hormone (ADH).
Main Methods:
- Studied 21 moderately ill children with Shigella dysenteriae type I.
- Measured glomerular filtration rate (GFR) using inulin and iohexol clearances.
- Assessed effective renal plasma flow (ERPF) via para-aminohippuric acid clearance.
- Quantified plasma renin, aldosterone, and ADH levels.
Main Results:
- HN children had higher hemoglobin and hematocrit than NN children.
- Inverse correlation between serum sodium and hemoglobin; direct correlation with urinary sodium and chloride.
- Direct correlations observed between aldosterone and hemoglobin, renin and systolic blood pressure.
- Inverse correlation between aldosterone and serum sodium; normal GFR and ERPF.
- Detectable ADH levels were present in both groups despite low serum osmolality.
Conclusions:
- Hyponatremia in shigellosis appears multifactorial.
- Normal renal function suggests hyponatremia is not due to volume expansion from reduced GFR.
- Inappropriate or physiological increase in ADH secretion may play a significant role.
- Increased fecal sodium losses could also contribute to hyponatremia.
Unlabelled:
Studies in Bangladesh have shown that the mortality in shigellosis is significantly higher in hyponatraemic (HN) than in normo- (NN) or hypernatraemic children. The aim of this study was to describe the effect of shigellosis on renal haemodynamics and sodium and water homeostasis before treatment was started. Twenty-one moderately ill children infected with Shigella dysenteriae type I were studied. Eight of them had a serum sodium concentration below 130 mmol/L. Renal function was determined by glomerular filtration rate measured by clearances of inulin and iohexol. Effective renal plasma flow was estimated by clearance of para-aminohippuric acid. Plasma renin, aldosterone and anti-diuretic hormone were also studied. The HN children had significantly higher haemoglobin and haematocrit levels than the NN group. There was an inverse correlation between serum sodium and haemoglobin, and a direct correlation between serum sodium and urinary sodium and urinary chloride. Direct correlations were found between serum aldosterone and haemoglobin, plasma renin and systolic blood pressure and an inverse correlation between serum aldosterone and serum sodium. Clearances of inulin and iohexol were normal. Detectable levels of ADH were found in both groups, despite low serum osmolalities.
Conclusion:
The HN state seems to be triggered by multiple factors. The normal glomerular filtration rate excludes a volume expansion secondary to reduced renal function. Inappropriate or a physiological increase of anti-diuretic hormone secretion may be of importance. The higher sodium losses in stools of the HN children might also be a factor contributing to the HN.