Hyponatremic dehydration: an analysis of 78 cases

Our purpose was to determine the frequency of convulsion in children with hyponatremic dehydration (HD). We also investigated whether or not there was a relationship between the severity of hyponatremia and the degrees of malnutrition in our region (Eastern Anatolia of Turkey) in where malnutrition is frequently observed. In this study, the clinical and laboratory findings of 78 patients with diarrhoea (acute, persistent or chronic diarrhoea) and HD were studied. When diarrhoea lasts longer than 2 and 4 weeks they were accepted as persistent and chronic diarrhoea, respectively. Patients were said to have HD if they had the clinical findings of dehydration associated with hyponatremia [Serum sodium (SNa) <130 mmol/L)]. Nutritional status of the children was assessed by the Gomez classification using weight for age; it was accepted as normal those were between 90%-110%, mild malnutrition 75%-89%, moderate malnutrition 60%-74% and severe malnutrition <60%. Of 78 patients, 40 were boys, 38 were girls. The age and weight of the patients ranged from 40 days to 36 months (8.94 +/- 5.49 months) and from 2000 to 10,300 g (5535.25 +/- 1702.10 g) respectively. All patients except four had malnutrition; 15 (20.3%) had mild malnutrition, 30 (40.5%) had moderate malnutrition and 29 (39.2%) had severe malnutrition. Forty-seven patients had acute, 16 patients had persistent, and 15 patients had chronic diarrhoea. SNa levels were between 104 and 129 mmol/L (121.21 +/- 6.12 mmol/L). There was not statistically a significant difference between SNa level and the degree of malnutrition, and SNa level and the types (acute, persistent or chronic) of diarrhoea (p > 0.05). Of 78 patients, 12 (15.3%) patients had convulsion, of whom eight had convulsion associated with fever. Convulsion was noted in nine (19.1%) and three (18.7%) patients with acute and persistent diarrhoea, respectively (p > 0.05). Also, we observed that when hyponatremia was severer, convulsions tended to be more occuring (p < 0.05). Five (6.4%) children died and all of them had severe malnutrition and septicemia. We determined that the frequency of convulsion in HD was 15.3% (12/78), and there was not a difference between the cases of acute, persistent and chronic diarrhoea for the frequency of convulsion. We also found a significant difference was not present between SNa level and the degree of malnutrition, and between SNa level and the types (acute, persistent or chronic) diarrhoea. However, we observed that when hyponatremia was severer, convulsions tended to be more occuring.