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Hyponatremia in sick children: a marker of serious illness
S Singhi1, S V Prasad, K S Chugh
1Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh.
Insights
Hyponatremia, or low serum sodium, in sick children is linked to longer hospital stays and increased mortality. This condition indicates a poorer illness outcome, especially in severe cases.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Biochemistry
- Critical Care
Background:
- Hyponatremia is a common electrolyte imbalance in acutely ill children.
- The prognostic significance of hyponatremia at admission requires further elucidation.
Purpose of the Study:
- To investigate the association between hyponatremia and clinical outcomes in pediatric emergency care.
- To correlate serum sodium levels at hospitalization with length of stay and mortality.
Main Methods:
- Prospective study of 727 children (up to 12 years) admitted to emergency care.
- Serum sodium concentration measured at admission.
- Correlation analysis of serum sodium with hospital stay duration and mortality rates.
Main Results:
- Children with hyponatremia (serum sodium <= 130 mEq/L) had a 30% longer hospital stay (7.7 days vs. 5.9 days).
- Mortality rates were significantly higher in hyponatremic children (17% for <125 mEq/L, 9.3% for 126-130 mEq/L) compared to normonatremic children (5.3%).
- Prognosis was worse in hypotonic-euvolemic hyponatremia compared to hypovolemic hyponatremia.
Conclusions:
- Hyponatremia at admission is a significant indicator of poor prognosis in acutely ill children.
- Lower serum sodium levels correlate with prolonged hospitalization and increased mortality risk.
- Early identification and management of hyponatremia are crucial in pediatric emergency settings.
Abstract:
To study the association between hyponatremia (serum sodium < or = 130 mEq/L) and the final outcome of the illness, we correlated serum sodium concentration at the time of hospitalization with the length of hospital stay and mortality in a prospective study of 727 sick children aged upto 12 years, who sought emergency care. The mean +/- SE duration of hospital stay (7.7 +/- 0.4 days) among 217 children with serum sodium < or = 130 mEq/L was about 30% longer than that of 510 children with serum sodium > or = 131 mEq/L (5.9 +/- 0.3 days) (p < 0.01). This remained unaffected by the sex and the age group, but was further prolonged in children with hypotonic--euvolemic type of hyponatremia as compared to those with hypovolemic hyponatremia. The mortality rate in 510 children with normal serum sodium concentration (> or = 131 mEq/L) was 5.3%. In contrast, it was 17% in 47 children with serum sodium < 125 mEq/L (Relative Risk 3.2; 95% Confidence Interval 1.6-6.7) and 9.3% in 170 children with serum sodium between 126-130 mEq/L (Relative Risk--1.8; 95% Confidence Interval 1.1-3.7) (p < 0.01). Hyponatremia in acutely ill children at admission indicates a poor prognosis.