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Hyponatremia in sick children seeking pediatric emergency care
S V Prasad1, S Singhi, K S Chugh
1Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh.
Insights
Hyponatremia, low serum sodium, is common in hospitalized children, particularly during summer. Pneumonia and diarrhea are frequent causes, with dilutional hyponatremia prevalent in infections and hypovolemic in diarrhea.
Area of Science:
- Pediatrics
- Clinical Medicine
- Nephrology
Background:
- Hyponatremia (serum sodium < 130 mEq/L) is a frequent electrolyte disturbance in pediatric emergency care.
- Understanding its causes and types is crucial for effective management in hospitalized children.
Purpose of the Study:
- To determine the frequency, clinical characteristics, and etiological factors of hyponatremia in children requiring emergency hospitalization.
- To differentiate the types of hyponatremia based on clinical presentation and laboratory findings.
Main Methods:
- Prospective evaluation of 727 children aged 12 years or younger admitted via emergency care.
- Assessment included clinical evaluation, serum sodium levels, plasma and urine osmolality, and urine sodium.
Main Results:
- Hyponatremia was observed in 29.8% of children, with higher incidence in summer (36%) versus winter (24%).
- Common causes included acute lower respiratory infections (20%), acute diarrhea (20%), meningitis/encephalitis (12%), and septicemia (8%).
- Dilutional (hypotonic-euvolemic) hyponatremia predominated in infections, while hypovolemic hyponatremia was seen in diarrhea.
Conclusions:
- Hyponatremia is a significant issue in sick children needing emergency care, especially during summer.
- Recognizing the specific causes and types of hyponatremia is essential for appropriate pediatric patient management.
Abstract:
This prospective study evaluated the frequency, clinical characteristics and causes of hyponatremia (serum sodium < 130 mEq/L) in 727 children upto 12 years of age, who were brought for emergency care, and needed hospitalization. Hyponatremia was found in 29.8% and was more frequent in summer (36%; 123/341) than in winter (24%; 94/386) (p < 0.001). Acute lower respiratory infections (pneumonia) and acute diarrhea each accounted for 20% cases of hyponatremia; others were accounted for by meningitis/encephalitis (12%) septicemia (8%), and renal, heart and liver diseases (6-7% each). Clinical evaluation and concurrent plasma and urinary osmolality and urine sodium suggested that hyponatremia associated with pneumonia, meningitis/encephalitis, septicemia, seizures and miscellaneous diseases was of hypotonic-euvolemic (dilutional) type in more than 80% patients while in all children with acute diarrhea it was of hypovolemic type. The study has shown that hyponatremia occurs frequently in sick children requiring emergency care, especially in summer months, and should receive appropriate attention in the management plan.