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Water electrolyte homeostasis in acute bronchiolitis
U Poddar1, S Singhi, N K Ganguli
1Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandgiarh.
Insights
Infants with acute bronchiolitis experience water retention due to impaired kidney function. Careful fluid management is crucial to prevent water intoxication in these young patients.
Area of Science:
- Pediatrics
- Nephrology
- Critical Care Medicine
Background:
- Acute bronchiolitis is a common respiratory illness in infants, often necessitating hospitalization and intravenous fluid therapy.
- Water retention and electrolyte imbalances have been observed in pediatric pulmonary conditions, linked to impaired renal water excretion.
Purpose of the Study:
- To investigate water and electrolyte changes in infants hospitalized with acute bronchiolitis.
- To compare these changes during the acute phase versus recovery.
- To assess renal water handling capacity in affected infants.
Main Methods:
- Studied 20 infants hospitalized for acute bronchiolitis, measuring serum sodium, plasma osmolality, and urinary parameters.
- Assessed body water compartments and renal water handling (water load excretion, free water excretion capacity) on admission and during recovery.
- Compared acute stage measurements with those obtained after recovery.
Main Results:
- Infants showed decreased serum sodium and plasma osmolality during acute illness compared to recovery.
- Urinary sodium and osmolality were significantly lower on admission.
- Total body water excess, primarily in extracellular compartments, was observed.
- Seven out of ten infants exhibited impaired renal water excretion, with significantly improved free water clearance upon recovery.
Conclusions:
- Acute bronchiolitis in infancy is characterized by significant water retention.
- Impaired renal water excretion is the primary cause of this water retention.
- Judicious fluid therapy is essential in managing severe bronchiolitis to avoid potential water intoxication.
Abstract:
Children with acute bronchiolitis frequently require hospitalization and parenteral fluid therapy. Water retention due to impaired renal water excretion has been described in several pulmonary conditions in children. We studied 20 infants (3.6 +/- 2.9 months), hospitalized consecutively for acute bronchiolitis for water and electrolyte changes during the acute stage and compared them to those on recovery. Serum sodium and plasma osmolality, urinary sodium and osmolality were measured in all infants. Ten infants each were assigned alternatively to study body water compartment or renal water handling (water load excretion and free water excretion capacity) on the day of hospitalization and after recovery. Mean ( +/- SD) value of serum sodium of the infants at admission was 132.7 +/- 7.2 mEq/L which increased to 137.1 +/- 5.4 mEq/L on recovery (p < 0.05). Plasma osmolality changed from 284 +/- 14 mOsm/kg at admission to 294 +/- 10 mOsm/kg at recovery (p < 0.05). There was a significant decrease in urinary sodium from 54 +/- 39 mEq/L to 20 +/- 18 mEq/L and urinary osmolality from 415 +/- 213 mOsm/kg to 252 +/- 204 mOsm/kg at admission and at recovery, respectively. All 10 infants showed significant increase in total body water (mean +/- SD; 22.8 +/- 7.5 ml/kg) at admission as compared to that at recovery. The total body water (TBW) excess was mainly in extracellular water compartment (16.3 +/- 3.6 ml/kg). Seven of 10 infants had significant impairment in renal water excretion. Increase in maximum free water clearance of these 7 infants on recovery was 0.69 +/- 0.27 ml/min, i.e., 15 times more than that at admission. It is concluded that bronchiolitis of infancy is characterized by water retention which is caused by impaired renal water excretion. In the management of severe bronchiolitis careful attention to fluid therapy is mandatory; liberal fluid therapy may lead to water intoxication.