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Extreme sodium derangement in a paediatric inpatient population
Insights
Extreme sodium disturbances in children often occur after hospital admission, with significant neurological symptoms and high mortality rates. The underlying condition dictates the outcome for survivors.
Area of Science:
- Pediatric Nephrology
- Clinical Chemistry
- Hospital Medicine
Background:
- Extreme sodium derangements, including hypernatremia and hyponatremia, represent critical electrolyte imbalances in pediatric patients.
- These disturbances can arise from various underlying medical conditions and iatrogenic causes within a hospital setting.
Purpose of the Study:
- To investigate the causes, clinical manifestations, and outcomes of severe plasma sodium disturbances in hospitalized children.
- To identify common etiologies and associated symptoms in pediatric patients with extreme hypernatremia or hyponatremia.
Main Methods:
- A retrospective analysis of pediatric inpatients with plasma sodium levels ≥ 165 mmol/L or ≤ 115 mmol/L over a 72-month period.
- Review of 27 cases of hypernatremia and 21 cases of hyponatremia, focusing on onset, etiology, symptoms, and outcomes.
Main Results:
- Over half of the cases (57%) developed after hospital admission.
- Gastroenteritis was the leading cause of hypernatremia, while water overload was common in hyponatremia.
- Neurological symptoms were prevalent in both groups (79% hypernatremia, 58% hyponatremia), with significant mortality (37% hypernatremia, 19% hyponatremia).
Conclusions:
- Severe sodium disturbances in pediatric inpatients frequently emerge during hospitalization and stem from diverse causes.
- High rates of neurological complications and mortality underscore the severity of these conditions.
- Patient outcomes are primarily determined by the underlying disease process rather than the sodium derangement itself.
Objective:
To determine the aetiology, symptoms and outcome of extreme sodium derangement in a paediatric inpatient population.
Methodology:
A retrospective study of children with extreme disturbance of their plasma sodium (> or = 165 mmol/L or < or = 115 mmol/L) admitted to a tertiary referral centre during a 72-month period.
Results:
Twenty-seven cases of hypernatraemia and 21 of hyponatraemia were reviewed. Sodium disturbance developed after hospital admission in 27/57 cases (57%). Gastroenteritis was the most common cause of hypernatraemia (8/27; 30%), four of 27 (15%) had iatrogenic hypernatraemia. Water overload accounted for 8/21 (38%) cases of hyponatraemia. Neurologic symptoms occurred in 19/24 (79%) with hypernatraemia and in 11/19 (58%) with hyponatraemia. Ten (37%) with hypernatraemia and four (19%) with hyponatraemia died. A deterioration in functional status was seen in two patients with hypernatraemia. There was no apparent deterioration in the survivors with hyponatraemia.
Conclusion:
Extreme sodium disturbance often develops after admission to hospital and is caused by a variety of diseases and interventions. Neurologic symptoms are common and the mortality rate is high. The outcome in survivors is survivors is most likely to be dependent on the underlying disease process.