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Fluid management in children with diarrhea-related hyponatremic-hypernatremic dehydration: a retrospective study of
Celebi Kocaoglu1, Ece Selma Solak, Cengizhan Kilicarslan
11Department of Pediatrics, 2Department of Pediatric Nephrology; Konya Education and Research Hospital, Konya, Turkey.
Insights
Children with diarrhea-related dehydration require close monitoring of electrolytes and creatinine. Individualized intravenous fluid therapy is crucial, as no single approach suits all pediatric patients.
Area of Science:
- Pediatric Intensive Care
- Nephrology
- Pediatric Gastroenterology
Background:
- Diarrhea is a common cause of dehydration in children.
- Electrolyte imbalances, specifically hyponatremia and hypernatremia, can complicate dehydration management.
- Serum creatinine and electrolyte levels are critical indicators of dehydration severity and patient status.
Purpose of the Study:
- To investigate serum creatinine and electrolyte status in children experiencing diarrhea-related hyponatremic or hypernatremic dehydration.
- To evaluate the impact of fluid concentration on the duration of serum sodium level amelioration in these pediatric patients.
Main Methods:
- Retrospective evaluation of 83 pediatric patients admitted to the Pediatric Intensive Care Unit with diarrhea, dehydration, and electrolyte imbalance.
- Analysis included degree of dehydration, serum creatinine, electrolytes, blood gas, fluid therapy concentration, and use of acute peritoneal dialysis.
- Patients were categorized based on hyponatremia or hypernatremia and the concentration of intravenous fluids administered.
Main Results:
- Mean duration for serum sodium amelioration in hyponatremic patients was longer when fluids were administered at a higher concentration (53.7 ± 31.6 h) compared to appropriate concentration (33.9 ± 28.3 h).
- Similarly, hypernatremic patients showed a longer duration for serum sodium amelioration with higher concentration fluids (46.3 ± 32 h) versus appropriate concentration (34.7 ± 22.1 h).
- Acute peritoneal dialysis was used in a small percentage of patients (4.8% hyponatremic, 3.6% hypernatremic); overall mortality was 6%.
Conclusions:
- Children with severe diarrhea and dehydration require vigilant monitoring of clinical status, serum electrolytes, creatinine, and blood gases.
- Individualized intravenous fluid therapy is essential, as optimal management varies between pediatric patients.
- The concentration of administered fluids significantly impacts the time to normalize serum sodium levels.
Aim:
To investigate serum creatinine and electrolyte status of children with diarrhea-related hyponatremic or hypernatremic dehydration.
Methods:
Medical history of 83 patients admitted to the Pediatric Intensive Care Unit of the Konya Education and Research Hospital, Konya, Turkey with diarrhea, dehydration and electrolyte imbalance was retrospectively evaluated according to the degree of dehydration, serum creatinine, electrolytes, blood gas, approaches to the treatment such as content of given fluid, HCO3- and acute periotenal dialysis. Of 65 patients with hyponatremia, 44 (67.7%) were given fluids at appropriate concentration according to their age, and 21 (32.3%) were given fluids at higher concentration. Of 18 hypernatremic patients, 11 (61.1%) were given fluids at appropriate concentration for age, and seven (38.9%) were given fluids at higher concentration.
Results:
Mean duration of amelioration of serum sodium levels for those admitted with hyponatremia and given fluids at appropriate concentration for age and at higher concentration were 33.9 ± 28.3 h and 53.7 ± 31.6 h, respectively. Mean duration of amelioration of serum sodium levels for hypernatremics and given fluids at appropriate concentration for age and at higher concentration were 34.7 ± 22.1 h and 46.3 ± 32 h, respectively. Four (4.8%) hyponatremic patients and three (3.6%) with hypernatremia were treated with acute peritoneal dialysis. Mortality rate was 6% (five of all patients).
Conclusion:
The children with severe diarrhea should be closely followed-up as to clinical examination, serum electrolytes, creatinine and blood gases, and because no single intravenous fluid management is optimal for all children, intravenous fluid therapy should be individualized for each patient.
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