Research Article
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Year 2023, Volume: 9 Issue: 5 - September 2023, 1224 - 1231, 04.09.2023
https://doi.org/10.18621/eurj.1342084

Abstract

References

  • 1. Holliday MA, Segar WE. The maintenance need for water in parenteral fluid therapy. Pediatrics 1957;19:823-32.
  • 2. Holliday MA, Ray PE, Friedman AL. Fluid therapy for children: facts, fashions and questions. Arch Dis Child 2007;92:546-50.
  • 3. Freeman MA, Ayus JC, Moritz ML. Maintenance intravenous fluid prescribing practices among paediatric residents. Acta Paediatr 2012;101:e465-e8.
  • 4. Green J, Lillie J. Intravenous fluid therapy in children and young people in hospital N29. Arch Dis Child Educ Pract Ed 2017;102:327-31.
  • 5. Feld LG, Neuspiel DR, Foster BA, Leu MG, Garber MD, Austin K, et al. Clinical practice guideline: maintenance intravenous fluids in children. Pediatrics 2018;142:e20183083.
  • 6. Sachdev A, Pandharikar N, Gupta D, Gupta N, Gupta S, Venkatraman ST. Hospital-acquired hyponatremia in pediatric intensive care unit. Indian J Crit Care Med 2017;21:599-603.
  • 7. Padhi R, Panda BN, Jagati S, Patra SC. Hyponatremia in critically ill patients. Indian J Crit Care Med 2014;18:83-7.
  • 8. Sturdik I, Adamcova M, Kollerova J, Koller T, Zelinkova Z, Payer J. Hyponatraemia is an independent predictor of in-hospital mortality. Eur J Intern Med 2014;25:379-82.
  • 9. Hoorn EJ, Zietse R. Hyponatremia and mortality: moving beyond associations. Am J Kidney Dis 2013;62:139-49.
  • 10. Porcar MB, Cubillo BR, Domínguez-Roldán J, Rocha LÁ, Sanz MB, Montes MC, et al. Practical document on the management of hyponatremia in critically ill patients. Med Intensiva (Engl Ed) 2019;43:302-16.
  • 11. Chawla A, Sterns RH, Nigwekar SU, Cappuccio JD. Mortality and serum sodium: do patients die from or with hyponatremia? Clin J Am Soc Nephrol 2011;6:960-5.
  • 12. Waikar SS, Mount DB, Curhan GC. Mortality after hospitalization with mild, moderate, and severe hyponatremia. Am J Med 2009;122:857-65.
  • 13. Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated Pediatric Risk of Mortality score. Critical care medicine. 1996;24(5):743-52.
  • 14. Arieff AI, Ayus JC, Fraser CL. Hyponatraemia and death or permanent brain damage in healthy children. Br Med J 1992;304:1218-22.
  • 15. Judd B, Haycock G, Dalton R, Chantler C. Antidiuretic hormone following surgery in children. Acta Pædiatr 1990;79:461-6.
  • 16. Moritz ML, Ayus JC. Disorders of water metabolism in children. hyponatremia and hypernatremia. Pediatr Rev 2002;23:371-80.
  • 17. Hoorn EJ, Geary D, Robb M, Halperin ML, Bohn D. Acute hyponatremia related to intravenous fluid administration in hospitalized children: an observational study. Pediatrics 2004;113:1279-84.
  • 18. Bibi S, Bibi S, Gilani SYH, Shah SRA, ul Haq A, Billo AG. Frequency of hospital acquired hyponatremia in a pediatric tertiary care setting. J Ayub Med Coll Abbottabad 2015;27:560-3.
  • 19. 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;163:1652-6. e1.
  • 20. Wald R, Jaber BL, Price LL, Upadhyay A, Madias NE. Impact of hospital-associated hyponatremia on selected outcomes. Arch Intern Med 2010;170:294-302.
  • 21. Gill G, Huda B, Boyd A, Skagen K, Wile D, Watson I, et al. Characteristics and mortality of severe hyponatraemia-a hospital‐based study. Clin Endocrinol 2006;65:246-9.
  • 22. Price JF, Kantor PF, Shaddy RE, Rossano JW, Goldberg JF, Hagan J, et al. Incidence, severity, and association with adverse outcome of hyponatremia in children hospitalized with heart failure. Am J Cardiol 2016;118:1006-10.
  • 23. Gheorghiade M, Abraham WT, Albert NM, Gattis Stough W, Greenberg BH, O'Connor CM, et al. Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry. Eur Heart J 2007;28:980-8.
  • 24. Nzerue CM, Baffoe-Bonnie H, You W, Falana B, Dai S. Predictors of outcome in hospitalized patients with severe hyponatremia. J Natl Med Assoc 2003;95:335.
  • 25. Shimoyama Y, Umegaki O, Kadono N, Minami T. Hyponatremia tends to be associated with mortality, but is not significantly associated with increased mortality risk in critically ill patients with sepsis. J Clin Anesth 2021;72:110281.
  • 26. Peri A. Morbidity and mortality of hyponatremia. In: Peri A, Thompson CJ, Verbalis JG, eds., Disorders of Fluid and Electrolyte Metabolism: Focus on Natremia. Basel; New York: S Karger AG. 2019;52:36-48.
  • 27. Konstam MA, Udelson JE. Hyponatraemia and vasopressin in heart failure: markers or mediators? Eur J Heart Fail 2011;13:242-4.

The severity of hyponatremia worsens the outcome in pediatric intensive care patients

Year 2023, Volume: 9 Issue: 5 - September 2023, 1224 - 1231, 04.09.2023
https://doi.org/10.18621/eurj.1342084

Abstract

Objectives: Hyponatremia is known to increase mortality and morbidity in adult patients. However, the significance of hyponatremia in critically ill pediatric patients is unknown, unlike in adults. We tried to determine the prevalance of hyponatremia in critically ill children and whether the severity of hyponatremia contributes to hospital stay and mortality.

Methods: The results of 190 patients who met the inclusion criteria and were admitted to the pediatric intensive care unit between April 2014 and April 2017 were analyzed.

Results: Eighty-six (45.3%) patients developed hyponatremia at the time of hospitalization, and Hospital‑Acquired Hyponatremia (HAH) developed in 46 (24.2%) patients during the hospitalization. Fifty-eight (30.5%) patients were normonatremic. The patients in the HAH group were significantly more septic (p = 0.015). The duration of intensive care hospitalization was significantly longer in the HAH group (p < 0.001) and significantly less in the normonatremic group (p = 0.008). Total mortality was 41% (n = 78). There was no difference between the groups regarding mortality (p = 0.4). However, the degree of hyponatremia was associated with mortality. Mortality was 24.1% in mildly hyponatremic patients, 45.6% in moderate patients, and 58.8% in severe patients (OR: 2.636, 95% CI: 1.189-5.842; OR: 4.490, 95% CI:1.439-14.008, p = 0.01). We discovered that as hyponatremia severity increased, so did the length of stay in the intensive care unit, the need for invasive ventilation, and the need for vasoactive drugs (p = 0.009, p = 0.018, and p = 0.006, respectively).

Conclusions: Unlike adults, the prognostic value of hyponatremia in terms of mortality has not been determined in critically ill children. However, as the severity of hyponatremia increased, it was seen that the length of stay in the intensive care unit and mortality increased.

References

  • 1. Holliday MA, Segar WE. The maintenance need for water in parenteral fluid therapy. Pediatrics 1957;19:823-32.
  • 2. Holliday MA, Ray PE, Friedman AL. Fluid therapy for children: facts, fashions and questions. Arch Dis Child 2007;92:546-50.
  • 3. Freeman MA, Ayus JC, Moritz ML. Maintenance intravenous fluid prescribing practices among paediatric residents. Acta Paediatr 2012;101:e465-e8.
  • 4. Green J, Lillie J. Intravenous fluid therapy in children and young people in hospital N29. Arch Dis Child Educ Pract Ed 2017;102:327-31.
  • 5. Feld LG, Neuspiel DR, Foster BA, Leu MG, Garber MD, Austin K, et al. Clinical practice guideline: maintenance intravenous fluids in children. Pediatrics 2018;142:e20183083.
  • 6. Sachdev A, Pandharikar N, Gupta D, Gupta N, Gupta S, Venkatraman ST. Hospital-acquired hyponatremia in pediatric intensive care unit. Indian J Crit Care Med 2017;21:599-603.
  • 7. Padhi R, Panda BN, Jagati S, Patra SC. Hyponatremia in critically ill patients. Indian J Crit Care Med 2014;18:83-7.
  • 8. Sturdik I, Adamcova M, Kollerova J, Koller T, Zelinkova Z, Payer J. Hyponatraemia is an independent predictor of in-hospital mortality. Eur J Intern Med 2014;25:379-82.
  • 9. Hoorn EJ, Zietse R. Hyponatremia and mortality: moving beyond associations. Am J Kidney Dis 2013;62:139-49.
  • 10. Porcar MB, Cubillo BR, Domínguez-Roldán J, Rocha LÁ, Sanz MB, Montes MC, et al. Practical document on the management of hyponatremia in critically ill patients. Med Intensiva (Engl Ed) 2019;43:302-16.
  • 11. Chawla A, Sterns RH, Nigwekar SU, Cappuccio JD. Mortality and serum sodium: do patients die from or with hyponatremia? Clin J Am Soc Nephrol 2011;6:960-5.
  • 12. Waikar SS, Mount DB, Curhan GC. Mortality after hospitalization with mild, moderate, and severe hyponatremia. Am J Med 2009;122:857-65.
  • 13. Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated Pediatric Risk of Mortality score. Critical care medicine. 1996;24(5):743-52.
  • 14. Arieff AI, Ayus JC, Fraser CL. Hyponatraemia and death or permanent brain damage in healthy children. Br Med J 1992;304:1218-22.
  • 15. Judd B, Haycock G, Dalton R, Chantler C. Antidiuretic hormone following surgery in children. Acta Pædiatr 1990;79:461-6.
  • 16. Moritz ML, Ayus JC. Disorders of water metabolism in children. hyponatremia and hypernatremia. Pediatr Rev 2002;23:371-80.
  • 17. Hoorn EJ, Geary D, Robb M, Halperin ML, Bohn D. Acute hyponatremia related to intravenous fluid administration in hospitalized children: an observational study. Pediatrics 2004;113:1279-84.
  • 18. Bibi S, Bibi S, Gilani SYH, Shah SRA, ul Haq A, Billo AG. Frequency of hospital acquired hyponatremia in a pediatric tertiary care setting. J Ayub Med Coll Abbottabad 2015;27:560-3.
  • 19. 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;163:1652-6. e1.
  • 20. Wald R, Jaber BL, Price LL, Upadhyay A, Madias NE. Impact of hospital-associated hyponatremia on selected outcomes. Arch Intern Med 2010;170:294-302.
  • 21. Gill G, Huda B, Boyd A, Skagen K, Wile D, Watson I, et al. Characteristics and mortality of severe hyponatraemia-a hospital‐based study. Clin Endocrinol 2006;65:246-9.
  • 22. Price JF, Kantor PF, Shaddy RE, Rossano JW, Goldberg JF, Hagan J, et al. Incidence, severity, and association with adverse outcome of hyponatremia in children hospitalized with heart failure. Am J Cardiol 2016;118:1006-10.
  • 23. Gheorghiade M, Abraham WT, Albert NM, Gattis Stough W, Greenberg BH, O'Connor CM, et al. Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry. Eur Heart J 2007;28:980-8.
  • 24. Nzerue CM, Baffoe-Bonnie H, You W, Falana B, Dai S. Predictors of outcome in hospitalized patients with severe hyponatremia. J Natl Med Assoc 2003;95:335.
  • 25. Shimoyama Y, Umegaki O, Kadono N, Minami T. Hyponatremia tends to be associated with mortality, but is not significantly associated with increased mortality risk in critically ill patients with sepsis. J Clin Anesth 2021;72:110281.
  • 26. Peri A. Morbidity and mortality of hyponatremia. In: Peri A, Thompson CJ, Verbalis JG, eds., Disorders of Fluid and Electrolyte Metabolism: Focus on Natremia. Basel; New York: S Karger AG. 2019;52:36-48.
  • 27. Konstam MA, Udelson JE. Hyponatraemia and vasopressin in heart failure: markers or mediators? Eur J Heart Fail 2011;13:242-4.
There are 27 citations in total.

Details

Primary Language English
Subjects Pediatric Emergency, Pediatric Nephrology , Pediatric Intensive Care
Journal Section Original Articles
Authors

Arzu Oto 0000-0003-0229-2759

Seher Erdoğan 0000-0002-3393-3363

Mehmet Boşnak 0000-0002-8390-5109

Early Pub Date August 29, 2023
Publication Date September 4, 2023
Submission Date August 12, 2023
Acceptance Date August 26, 2023
Published in Issue Year 2023 Volume: 9 Issue: 5 - September 2023

Cite

AMA Oto A, Erdoğan S, Boşnak M. The severity of hyponatremia worsens the outcome in pediatric intensive care patients. Eur Res J. September 2023;9(5):1224-1231. doi:10.18621/eurj.1342084

e-ISSN: 2149-3189 


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