Hyponatremia and Its Effects on Prognosis in A Tertiary Pediatric Intensive Care Unit

Year 2023, Volume: 17 Issue: 5, 418 - 423, 25.09.2023

Özlem Yüksel Aksoy , Şuayip Keskin , Mustafa Orhan Duyar , Adem Dursun , Serkan Özsoylu , Binnaz Çelik , Murat Doğan , Funda Baştuğ

https://doi.org/10.12956/tchd.1346812

Abstract

Introduction: Hyponatremia is accepted as an independent risk factor in pediatric intensive care units. Many comorbidities such as infectious diseases, central nervous system problems and incorrect replacement solutions are blamed in the pathogenesis of hyponatremia. In this study, we aimed to investigate the etiology and prognosis of hyponatremia in a tertiary pediatric intensive care unit.

Materials and Methods: We retrospectively analyzed 342 pediatric patients hospitalized in the pediatric intensive care unit of Kayseri City Hospital. Patients with a serum sodium level below 135 mEq/L were considered hyponatremia. Critical hyponatremia was defined as serum sodium less than 125 mEq/L. Data on length of hospital stay, mortality and comorbidities were analyzed.

Results: The data of 342 pediatric patients were evaluated. The male/female ratio was 192/150 (56.1% vs. 43.9%). The mean age of the patients was 41.78 months (±57.7) (min-max 1-212). Twenty-five patients had serum sodium below 125 mEq/L, which could be defined as critical hyponatremia. The mean sodium was 131 (±3.3) mEq/L (min-max: 109-134). The levels of serum creatinine significantly differs before and after treatment (p<0.001). The mean resolution time of hyponatremia was 2.1 days (±1.29) (min-max: 1-12) Serum sodium was 125 mEq/L and below in a total of 23 patients. The mortality rate was 23% in all patients at the end of their follow-up.

Conclusions: Hyponatremia is a common problem in pediatric intensive care unit. Especially severe hyponatremia can be related with increased mortality. Close monitoring of sodium is needed in especially trauma patients and central pathologies as well as bronchopneumonia patients.

Keywords

child, hyponatremia, sodium

Hiponatremi ve Etkilerinin Üçüncü Basamak Pediatri Yoğun Bakım Hastalarında Değerlendirilmesi

Abstract

Giriş: Çocuk yoğun bakım ünitelerinde hiponatremi bağımsız bir risk faktörü olarak kabul edilmektedir. Hiponatreminin patogenezinde enfeksiyon hastalıkları, merkezi sinir sistemi sorunları ve yanlış replasman sıvılarının kullanımı gibi birçok faktör bulunmaktadır. Bu çalışmada üçüncü basamak bir pediatrik yoğun bakım ünitesinde hiponatreminin etiyolojisini ve prognozunu araştırmayı amaçladık.

Gereç ve Yöntemler: Kayseri Şehir Hastanesi 3. Basamak Çocuk Yoğun Bakım Ünitesi’nde yatan 342 çocuk hastayı retrospektif olarak inceledik. Serum sodyum düzeyi 135 mEq/L'nin altında olan hastalar hiponatremi olarak kabul edildi. Kritik hiponatremi, serum sodyumunun 125 mEq/L'den az olması olarak tanımlandı. Hastanede kalış süresi, mortalite ve komorbiditelere ilişkin veriler analiz edildi.

Bulgular: 342 pediatrik hastanın verileri değerlendirildi. Erkek/kadın oranı 192/150 (%56.1'e karşı %43.9) idi. Hastaların yaş ortalaması 41.78 ay (±57.7) (min-maks 1-212) idi. 25 hastada kritik hiponatremi olarak tanımlanabilecek 125 mEq/L'nin altında serum sodyumu vardı. Ortalama sodyum 131 (±3,3) mEq/L (min-maks: 109-134) idi. Serum kreatinin düzeyleri tedavi öncesi ve tedavi sonrası anlamlı farklılık gösterdi (p<0.001). Hiponatreminin ortalama düzelme süresi 2.1 gün (±1.29) (min-maks: 1-12) idi. Toplam 23 hastada serum sodyumu 125 mEq/L ve altındaydı. Takipleri sonunda tüm hastalarda mortalite oranı %23 idi.

Sonuç: Hiponatremi çocuk yoğun bakım ünitelerinde sık görülen bir sorundur. Özellikle ciddi hiponatremi artmış mortalite ile ilişkilendirilebilir. Akciğer enfeksiyonlarında, travma hastalarında ve santral sinir sistemi patolojilerinde serum sodyumunun yakından izlenmesi gerekmektedir.

Keywords

çocuk, hiponatremi, sodyum

References

• Lehtiranta S, Honkila M, Anttila S, Huhtamäki H, Pokka T, Tapiainen T. The incidence, hospitalizations, and deaths in acutely ill children with dysnatraemias. Acta Pediatr 2022;111:1630–7.
• Elliman MG, Vongxay O, Soumphonphakdy B, Gray A. Hyponatraemia in a lao pediatric intensive care unit: prevalence, associations, and intravenous fluid use. J Pediatr Child Health 2019;55:695–700.
• Mezzini G, Marasco S, Bertuccio A, Savioli G, Piccolela, Racca F, et al. Hyponatremia Related to Neurocritical Care: Focus on Diagnosis and Therapy: A Systematic Review. Rev Recent Clin Trials 2023;18:19-27.
• Elala G, Shimelis D. Patterns of electrolyte abnormalities in children 0-15 years of age admitted to Pediatric Emergency and Intensive Care Units of a Tertiary Hospital. IOSR-JDMS 2018;17:12-6.
• Padhi R, Panda BN, Jagati S, Patra SC. Hyponatremia in critically ill patients. Indian J Crit care med 2014;18:83-7.
• Naseem F, Saleem A, Mahar IA, Arif F. Electrolyte imbalance in critically ill paediatric patients. Pak J Med Sci 2019;35:1093e8.
• Aksoy ÖY, Gündüz M, Ünal Ö, Bostancı F, Çaycı FŞ, Bayrakcı US. A mysterious case with abdominal pain and syndrome of inappropriate anti-diuretic hormone secretion.Turk J Pediatr 2020;62:487-90.
• Yasir M, Mechanic OJ. Syndrome of Inappropriate Antidiuretic Hormone Secretion. In:StatPearls. Treasure Island (FL): StatPearls Publishing; March 6,2023. https://www.ncbi.nlm.nih.gov/books/NBK507777/
• Koksoy AY, Kurtul M, Ozsahin AK, Cayci FS, Tayfun M, Bayrakci US. Tolvaptan Use to Treat SIADH in a Child. J Pediatr Pharmacol Ther 2018;23:494-8.
• Berhanu Y, Yusuf T, Mohammed A, Meseret F, Habteyohans BD, Alemu A, et al. Hyponatremia and its associated factors in children admitted to the pediatric intensive care unit in eastern Ethiopia: a cross-sectional study. BMC Pediatr 2023;23:310.
• Al-Sofyani KA. Prevalence and clinical significance of hyponatremia in pediatric intensive care. J Pediatr Intensive Care 2019;8:130–7.
• Luu R, DeWitt PE, Reiter PD, Dobyns EL, Kaufman J. Hyponatremia in children with bronchiolitis admitted to the pediatric intensive care unit is associated with worse outcomes. J Pediatr 2013;163:1652-1656.e1.
• Yen C, Yu M, Lee J. ScienceDirect Serum electrolyte abnormalities in pediatric patients presenting to an emergency department with various diseases: Age-related differences. Pediatr Neonatol 2022;63:575-81.
• Bennani SL, Abouqal R, Zeggwagh AA, Madani N, Abidi K, Zekraoui A, et al. Incidence, causes and prognostic factors of hyponatremia in intensive care. Rev Med Interne 2003;24:224-9.
• Stanski NL, Gist KM, Pickett K, Brinton J, Sadlowski J, Wong HR, et al. Electrolyte derangements in critically ill children receiving balanced versus unbalanced crystalloid fluid resuscitation. BMC Nephrol 2022;23:388.
• Brossier DW, Tume LN, Briant AR, Jotterand Chaparro C, Moullet C, Rooze S, et al. SYSTEMATIC REVIEW ESPNIC clinical practice guidelines: intravenous maintenance fluid therapy in acute and critically ill children — a systematic review and meta analysis. Intensive Care Med 2023;16:1691-708.