Acute hyponatremia related to intravenous fluid administration in hospitalized children: an observational study.
OBJECTIVE
To develop hyponatremia (plasma sodium concentration [P(Na)] <136 mmol/L), one needs a source of water input and antidiuretic hormone secretion release to diminish its excretion. The administration of hypotonic maintenance fluids is common practice in hospitalized children. The objective of this study was to identify risk factors for the development of hospital-acquired, acute hyponatremia in a tertiary care hospital using a retrospective analysis.


METHODS
All children who presented to the emergency department in a 3-month period and had at least 1 P(Na) measured (n = 1586) were evaluated. Those who were admitted were followed for the next 48 hours to identify patients with hospital-acquired hyponatremia. An age- and gender-matched case-control (1:3) analysis was performed with patients who did not become hyponatremic.


RESULTS
Hyponatremia (P(Na) <136 mmol/L) was documented in 131 of 1586 patients with > or = 1 P(Na) measurements. Although 96 patients were hyponatremic on presentation, our study group consisted of 40 patients who developed hyponatremia in hospital. The case-control study showed that the patients in the hospital-acquired hyponatremia group received significantly more EFW and had a higher positive water balance. With respect to outcomes, 2 patients had major neurologic sequelae and 1 died.


CONCLUSIONS
The most important factor for hospital-acquired hyponatremia is the administration of hypotonic fluid. We suggest that hypotonic fluid not be given to children when they have a P(Na) <138 mmol/L.
Hoorn
Ewout J
EJ
Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.
Geary
Denis
D
Robb
Maryanne
M
Halperin
Mitchell L
ML
Bohn
Desmond
D
D000208:Acute Disease; D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D005440:Fluid Therapy; D006760:Hospitalization; D006801:Humans; D007010:Hyponatremia / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D007038:Hypotonic Solutions / Q000008:administration & dosage*; D007223:Infant; D007552:Isotonic Solutions / Q000008:administration & dosage; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012964:Sodium / Q000097:blood
D007038:Hypotonic Solutions; D007552:Isotonic Solutions; D012964:Sodium