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Hyponatremia in pediatric patients with HIV-1 infection
A Tolaymat1, F al-Mousily, J Sleasman
1Department of Pediatrics, University of Florida College of Medicine, Jacksonville, USA.
Insights
Hyponatremia affects over a quarter of children with human immunodeficiency virus (HIV-1) infection. Common causes include syndrome of inappropriate antidiuretic hormone and other medical conditions in pediatric HIV patients.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Medicine
- Medical Complications of HIV/AIDS
Background:
- Hyponatremia is a known complication in adults with acquired immunodeficiency syndrome (AIDS).
- Limited data exists on the frequency and clinical associations of hyponatremia in pediatric populations with human immunodeficiency virus (HIV-1) infection.
Purpose of the Study:
- To determine the frequency of hyponatremia in children with HIV-1 infection.
- To identify clinical associations and potential causes of hyponatremia in this pediatric cohort.
Main Methods:
- Retrospective study evaluating medical records of 86 children (age 4 months to 21 years) with HIV-1 infection.
- Analysis of serum sodium levels and co-occurring medical conditions at the time of hyponatremia diagnosis.
Main Results:
- Twenty-two children (26%) developed hyponatremia (serum sodium < 135 mEq/L).
- Common comorbidities included AIDS encephalopathy, cardiomyopathy, bacterial pneumonia, and tuberculosis meningitis.
- Attributed causes included syndrome of inappropriate antidiuretic hormone (SIADH), poor sodium intake, diarrheal losses, and diuretic use.
Conclusions:
- Hyponatremia is a significant complication in children with HIV-1 infection, occurring in over a quarter of cases.
- Multiple clinical factors and conditions are associated with hyponatremia in pediatric HIV patients.
- Further investigation into the management and prevention of hyponatremia in this population is warranted.
Abstract:
Hyponatremia has been recognized as a complication in adults with acquired immunodeficiency syndrome (AIDS). We did a retrospective study evaluating the medical records of 86 children (age 4 months to 21 years) with human immunodeficiency virus (HIV-1) infection to determine the frequency and clinical associations of hyponatremia. Twenty-two children (26%) developed hyponatremia (serum sodium < 135 mEq/L; range 104 to 134 mEq/L; mean 130 mEq/L). Fourteen were male; 18 of the 22 patients were black and 4 were white. At the time of hyponatremia, the children frequently had comorbid associations, including 8 (35%) with AIDS encephalopathy; 3 (14%) with cardiomyopathy; 3 (14%) using diuretics; 1 (5%) using pentamidine; 3 (14%) with bacterial pneumonia; 2 (9%) requiring gastric lavage feedings; 2 (9%) with tuberculosis meningitis; 2 (9%) with gastroenteritis; 1 (5%) with infection caused by Mycobacterium avium-intracellulare; 1 (5%) each with brain tumor and tumor metastasis to brain. The cause of hyponatremia was attributed to syndrome of inappropriate antidiuretic hormone in 8 children; poor sodium intake and/or excessive diarrheal losses in 5; and the use of diuretics in 3 patients. Mild hyponatremia with no identifiable cause was found in 5 patients.