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ISSN: 2394-4137 (E) 2394-6318 (P)

IJIMS.2019.114

Type of Article: Original Research

Volume 6; Issue 4: 2019

Page No.: 821-825

DOI: 10.16965/ijims.2019.114

ACUTE HYPONATREMIA AND HYPERNATREMIA RELATED TO INTRAVENOUS FLUID ADMINISTRATION IN HOSPITALIZED CHILDREN: A RANDOMIZED OBSERVATIONAL STUDY

Sciddhartha Koonwar *1, Kanchan Lata Azad 2, Sarvesh Kumar 3, Rashmi Kumar 4.

1,4 Department of Paediatric, King George Medical University, Lucknow, Uttar Pradesh, India.

2 Consultant Paediatrician, PMS, Uttar Pradesh, India.

3 Department of Community Medicine, Govt. Medical College, Datia, Madhya Pradesh, India.

Address for correspondence: Dr. Sciddhartha Koonwar, Associate Professor and in-charge Paediatric Intensive Care, Department of Paediatrics, King George medical University, Lucknow, India. Mobile: +91 9415102691 E-Mail: artha12sciddha@gmail.com

ABSTRACT:

Background: Intravenous fluid and electrolyte therapy in most of the acutely ill hospitalized children has been the cornerstone of medical practice for a well over 50 years.

Objective: To determine optimal maintenance fluid therapy by comparing the incidence of hyponatremia or hypernatremia in hospitalised children.

Methods: A prospective Randomized study done in PICU in patients admitted to paediatric emergency. The study was conducted between September 2007 to May 2008. Children of age group 1 month to 16 years were included. The fluid groups were divided into four groups. SPSS version 18 was used for analysis.

Results: The mean age in group I is 4.42, in group 2 is 3.84, in group 3 is 3.67 and in group 4 is 4.45. The mean serum sodium levels in fluid group 1 is 137.4 mmol/L, in fluid group II 138.2 mmol/L, in fluid group III is 138.9 mmol/L and fluid group IV is 137.8 mmol/L. After initiating maintenance fluid therapy serum sodium levels changed in each group. As we can see in group 1 mean serum sodium level at the start of the therapy is 137.43 mmol/L and after 24 hours of hypotonic fluid infusion it reduced to 135.4 mmol. 69 patients had hyponatremia and 44 had hypernatremia.

Conclusion: Amount of free fluid in the IV maintenance fluid can be factor in causing hypernatremia. Caution is warranted to guard off a rapid fall of serum sodium level.

Key words: Hyponatremia, Hypernatremia, electrolytes, PICU.

REFERENCES

  1. D Taylor, A Durward. Pouring salt on troubled water: the case for isotonic parenteral maintenance solution. Arec Dis Child 2004;89:411-14.
  2. Arieff AI, Ayus JC, Fraser CL. Hyponatremia and death or permanent brain damage in healthy children. BMJ.1992;304:1218-1222.
  3. Halberthal M, Halperin ML, Bohn D. Lesson of the week: acute hyponatremia in children admitted to hospital: retrospective analysis of factors contributing to its development and resolution. BMJ.2001;322:780-782.
  4. McJunkin JE, de los Reyes EC, Irazuzta JE, et al La Crosse encephalitis in children. N Engl J Med. 2001;344:801-807.
  5. Dhawan A, NBarang A, Singhi S. Hyponatremia and the inappropriate ADH syndrome in pneumonia. Ann Trop Paediatr. 1992;12:455-462.
  6. Armour A. Dilutional hyponatremia. A cause of massive fatal intraoperative cerebral oedema in a child undergoing renal transplantation. J Clin Pathol. 1997;50:444-446.
  7. The maintenance need for water in parenteral fluid therapy, Malcolm A Holliday and WE segar, Pediatrics;1957;19:823-832.
  8. 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;113:1279-1284.
  9. Hatherill M. Rubbing salt in the wound. Arch Dis Child. 2004;89:414-418.
  10. Hoorn EJ, Geary D, Robb M, Hslperin ML, Bohn D. Acute hyponatremia related to intravenous fluid administration in hospitalized children: an observational study. Pediatrics 2004;113:1279-1284.
  11. Steele A, Gowrishankar M, Abrahamson S, Mazer D, Feldman RD, Halperin ML. Postoperative hyponatremia despite near-isotonic saline infusion: a phenomenon of desalination. Annals of Internal Medicine. 1997 Jan 1;126(1):20-5.

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