Hypernatremia in Children With Diarrhea: Presenting Features, Management, Outcome, and Risk Factors for Death

Area of Science:

• Pediatrics
• Infectious Diseases
• Public Health

Background:

• Hypernatremic diarrhea poses a significant threat to children, particularly in resource-limited settings.
• Understanding the clinical spectrum and risk factors is crucial for improving outcomes.

Purpose of the Study:

• To investigate the magnitude, clinical features, treatment, and outcomes of hypernatremic diarrhea in children.
• To identify risk factors associated with fatal outcomes in this pediatric population.

Main Methods:

• Retrospective review of two datasets of children (<15 years) admitted with diarrhea and hypernatremia (serum sodium ≥150 mmol/L) at Dhaka Hospital, icddr, b.
• Logistic regression analysis was used to identify risk factors for mortality.

Main Results:

• Prevalence of hypernatremia was 5.1% and 2.4% in the study periods.
• Case fatality rates were 15% and 19%.
• Risk factors for death included serum sodium ≥170 mmol/L, nutritional edema, hypoglycemia, respiratory distress, and absent peripheral pulses.

Conclusions:

• Managing children with hypernatremia using oral rehydration salts (ORS) or ORS following intravenous fluid, if indicated, may help reduce mortality.
• Early recognition and appropriate fluid management are critical for improving survival rates in pediatric hypernatremic diarrhea.