title: Pulmonary edema in meningococcal septicemia associated with reduced epithelial chloride transport.
abstract: OBJECTIVE
  To test the hypothesis that meningococcal septicemia-related pulmonary edema is associated with a systemic abnormality of epithelial sodium and chloride transport and to investigate an association with hormones regulating Na transport.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  The 24-bed pediatric intensive care unit and pediatric wards of Royal Liverpool Children's Hospital.
  
  
  METHODS
  Consecutive children admitted to the pediatric intensive care unit and pediatric wards with a diagnosis of meningococcal septicemia and children (controls) with noninfectious critical illness receiving ventilatory support in the pediatric intensive care unit.
  
  
  RESULTS
  We measured sweat and saliva electrolytes, renal electrolyte excretion, nasal potential difference, and aldosterone, thyroxine, and cortisol levels. Pulmonary edema was diagnosed by chest radiography and its severity quantified by calculation of ventilation index at admission and duration of mechanical ventilation. We recruited 17 patients with severe meningococcal septicemia (nine patients with pulmonary edema), 14 patients with mild meningococcal septicemia, and 20 controls. Sweat and saliva Na and Cl concentrations and renal Na excretion were significantly (p < .05) higher in patients with pulmonary edema compared with controls. Nasal potential difference and amiloride response in patients with pulmonary edema were not significantly different to controls, but response to a low Cl solution was reduced in the nasal airway of patients with pulmonary edema (p < .05). Sweat and saliva chloride concentrations correlated significantly and better with ventilation index and duration of ventilation than sodium concentrations. Aldosterone, thyroxine, and cortisol levels were not significantly different between groups.
  
  
  CONCLUSIONS
  We have confirmed that meningococcal septicemia-related pulmonary edema is associated with reduced systemic sodium and chloride transport. Features of reduced Cl transport were most closely associated with markers of respiratory compromise, and this was supported by the reduced chloride channel function detected on nasal potential difference measurement.
authors.affiliation: Institute of Child Health, University of Liverpool, UK. michael_eisenhut@yahoo.com
authors.forename: Michael
authors.initials: M
authors.lastname: Eisenhut
authors.forename: Helen
authors.initials: H
authors.lastname: Wallace
authors.forename: Paul
authors.initials: P
authors.lastname: Barton
authors.forename: Erol
authors.initials: E
authors.lastname: Gaillard
authors.forename: Paul
authors.initials: P
authors.lastname: Newland
authors.forename: Michael
authors.initials: M
authors.lastname: Diver
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Southern
mesh_terms: D000450:Aldosterone / Q000502:physiology; D016470:Bacteremia / Q000150:complications*; D002675:Child, Preschool; D002712:Chlorides / Q000378:metabolism*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000502:physiology; D015278:Intensive Care Units, Pediatric; D017136:Ion Transport; D007668:Kidney / Q000378:metabolism; D008297:Male; D008589:Meningococcal Infections / Q000150:complications*; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000209:etiology* / Q000378:metabolism* / Q000473:pathology; D012121:Respiration, Artificial; D020545:Respiratory Mucosa / Q000378:metabolism*; D012469:Salivary Glands / Q000378:metabolism; D012964:Sodium / Q000378:metabolism; D013542:Sweat / Q000378:metabolism; D013974:Thyroxine / Q000502:physiology
chemical_list: D002712:Chlorides; D000450:Aldosterone; D012964:Sodium; D013974:Thyroxine; D006854:Hydrocortisone