title: Management of hyponatremic seizures in children with hypertonic saline: a safe and effective strategy.
abstract: OBJECTIVE
  To study efficacy and safety of hypertonic saline administration in the management of hyponatremic seizures.
  
  
  METHODS
  Retrospective, observational, cross-sectional study with factorial design.
  
  
  METHODS
  In-patient population in a university hospital.
  
  
  METHODS
  All children admitted with serum sodium concentrations less than 125 mmol/L. Sixty-nine episodes of severe hyponatremia in 60 children were reviewed. Forty-one of these children presented with seizures.
  
  
  METHODS
  Twenty-five of 41 seizure patients received an iv bolus of 4 to 6 mL/kg body weight of 3% saline. Twenty-eight patients were treated with a benzodiazepine and/or phenobarbital with or without the subsequent administration of hypertonic saline.
  
  
  RESULTS
  Thirteen treatment failures and ten instances of apnea occurred among the 28 patients treated with benzodiazepine/phenobarbital. Administration of hypertonic saline resulted in resolution of seizures and apnea in all cases. Those patients receiving 3% saline had a higher serum sodium increase rate from 0 to 4 hrs than the remaining patients (3.1 +/- 1.3 vs. 1.7 +/- 1.2 mmol/L.hr, p less than .01). None developed subsequent neurologic deterioration or clinical manifestations of osmotic demyelination syndrome.
  
  
  CONCLUSIONS
  Treatment of hyponatremic seizures with routine anticonvulsants may be ineffective and is associated with a considerable incidence of apnea. A rapid increase in the serum sodium concentration by 3 to 5 mmol/L with the use of hypertonic saline is safe and efficacious in managing acute symptomatic hyponatremia.
authors.affiliation: Department of Pediatrics, Children's Hospital of Michigan, Detroit 48201.
authors.forename: A P
authors.initials: AP
authors.lastname: Sarnaik
authors.forename: K
authors.initials: K
authors.lastname: Meert
authors.forename: R
authors.initials: R
authors.lastname: Hackbarth
authors.forename: L
authors.initials: L
authors.lastname: Fleischmann
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use; D001049:Apnea / Q000209:etiology; D001569:Benzodiazepines / Q000627:therapeutic use; D001923:Brain Chemistry / Q000502:physiology; D001927:Brain Diseases / Q000209:etiology / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D006801:Humans; D007010:Hyponatremia / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D007223:Infant; D007231:Infant, Newborn; D010634:Phenobarbital / Q000627:therapeutic use; D012189:Retrospective Studies; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*; D012640:Seizures / Q000188:drug therapy* / Q000209:etiology; D012964:Sodium / Q000097:blood; D014882:Water-Electrolyte Balance / Q000502:physiology
chemical_list: D000927:Anticonvulsants; D012462:Saline Solution, Hypertonic; D001569:Benzodiazepines; D012964:Sodium; D010634:Phenobarbital