Impact of Dysnatremia on Pediatric Intensive Care Mortality

Abstract

Objective: Fragile nature of the patients in the pediatric intensive care unit (PICU) can lead to severe electrolyte imbalances with life-threatening consequences. Dysnatremia is one of the most common disorders in this setting. This study aimed to investigate the causes, severity and concomitant diseases of dysnatremia in the PICU and factors affecting mortality in these patients. Material and Methods: This study was carried out between March 2013 and October 2014 in Ankara Children’s Hematology Oncology Training and Research Hospital. The patients admitted to PICU between 1 month and 18 years of age were included in the study. Hypernatremic patients were grouped as mild (145>Na≥160 mEq/L) and severe (Na>160 mEq/L); and hyponatremic patients were also grouped as mild (120≤Na <135 mEq/L) and severe (Na<120 mEq/L). Results: Out of the 101 dysnatremic patients (57 male/ 44 female) with a mean age of 79±71 months, 60% had hypernatremia, 40% had hyponatremia. Eighty-nine (88.1%) of the dysnatremic patients had comorbid chronic diseases, with central nervous system (CNS) disorders as the leading cause. The overall mortality rate of PICU was 17%, and the mortality rate of dysnatremic patients was 53%. The presence of concomitant chronic diseases was associated with increased mortality [OR, 3.84 (CI %95, 0.9-15.1)]. Mortality was more common in patients with severe and uncorrected hypernatremia, respectively (p=0.005, p=0.010). Conclusion: Dysnatremia is frequent in PICU. The presence of chronic comorbidities, severe and uncorrected dysnatremia increases the risk of mortality in the PICU. Awareness of this risk is important to improve survival in these vulnerable population.

Keywords

• hyponatremia
• hypernatremia
• cerebral salt wasting
• diabetes insipidus

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