Publication:

Hyponatremia in critically ill mechanically ventilated children

Background Hyponatremia is a serious adverse event in the paediatric critical care population is especially complex as many patients require multiple continuous infusion and excess fluid volumes due to hypovolemic shock or blood pressure instability. Acute hyponatremia poses an immediate danger to the central nervous system.  Administration of hypotonic maintenance fluids may worsen this. Hyponatremia can eventually lead to seizure and death depending magnitude and severity of onset. Hyponatremia is a common electrolyte disturbance occurring in critically ill patients. Symptoms range from nausea and malaise, with mild reduction in the serum sodium, to lethargy, decreased level of consciousness, headache, seizures and coma. The treatment of hyponatremia depends on the duration of hyponatremia and volume status of the patients. There is serious neurologic sequel if hyponatremia is inappropriately treated.

Methods The present retrospective observational study was conducted in the pediatric ICU ward of Department of Pediatrics at Dr. B.R.A.M. Hospital associated Pt. J.N.M. Medical College, Raipur (C.G.), India during study period from April 2015 to September 2015. The study was carried out hyponatremia in children between  the  age  group  of  >1 months  to 13 years  presenting with critically illness need mechanical ventilation admitted in ICU were  included  in  the  study.  Sample size was fixed at 84. The patient’s clinical data were recorded in all the cases. Investigations were done on the day of admission in who were clinically critically ill and had an initial serum sodium value           <135 mEq/L. Data was expressed as mean ± S.D. and percentage depending on distribution of data and as percentage.

Results In the current study, maximum admitted subjects belonged to infancy (<1year) 31 subjects (35.7%), 17 of them were male and 14 were female. Out of total subjects 49 (58.3%) were male and 35 (41.7%) were females. Distribution of disease associated was studied in the subjects and maximum subjects were found to be suffering from septicemia (19 subjects, 22.6%). Frequency of hyonatremia is more (77.4%) in age group less than 1 year. Already admitted subjects showed significantly higher duration of illness (23.7±59.3 days) compared to newly admitted subjects (9.4±19.8 days). Incidence rate of mild hyponatremia is more (52%). Significant difference was noted in IV Fluids administered in study subjects who were previously admitted and newly admitted.

Conclusions Current study denotes hyponatremia is a common finding in critically sick patients, it is more common in infants and patients with MODS &Meningoencephalitis diseased and so we need to be highly vigilant in these children.