title: [Association between moderate-severe bronchiolitis and syndrome of inappropriate antidiuretic hormone secretion in emergency departments].
abstract: OBJECTIVE
  To identify clinical characteristics that may lead to the early recognition of patients admitted to the hospital for moderate-to-severe bronchiolitis with urine results associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH).
  
  
  METHODS
  A prospective observational study was conducted, spanning the bronchiolitis epidemic season (October 2012-March 2013), including all children who were admitted to the hospital with a diagnosis of moderate-to-severe bronchiolitis. The following criteria were used to establish a diagnosis of SIADH: urine sodium level of 40 mmol/L or greater, urine osmolarity above 500 mosm/Kg, and urine density of 1020 g/L or greater. Demographic characteristics, ventilation mode and clinical outcome were also analyzed. A comparison was made between those patients that met urine SIADH criteria and those who did not.
  
  
  RESULTS
  A total of 126 children were included, and 23 (18.6%) of them had urine SIADH criteria. Patients in this group had a higher incidence of pneumonia and/or atelectasis on chest X-Ray (21.7% vs. 1.9%, P=.002), worse response to bronchodilator treatment with nebulized adrenaline (69,5% vs. 28,1%, P=.016), more need for respiratory assistance (high flow oxygen therapy (17.4% vs. 7.7%, p=.016), or non-invasive mechanical ventilation (13% vs. 5.8%, P=.034), and more admissions to the PICU (26.1% vs. 6.8%, P=.007).
  
  
  CONCLUSIONS
  Patients older than one month with acute moderate bronchiolitis and urine SIADH criteria have worse clinical courses and more need for non-invasive mechanical ventilation, PICU admission, and have a higher incidence of pneumonia on chest X-ray. For that reason, it is recommended to collect a urine sample from these patients to allow an early diagnosis of SIADH, and thus early treatment of fluid and electrolyte abnormalities.
authors: Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España. Electronic address: blankmajal@hotmail.com.
authors: B
authors: B
authors: Toledo del Castillo
authors: Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors: E
authors: E
authors: González Ruiz de León
authors: Sección de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors: A
authors: A
authors: Rivas García
authors: Sección de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors: P
authors: P
authors: Vázquez López
authors: Sección de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors: M C
authors: MC
authors: Miguez Navarro
authors: Sección de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors: R
authors: R
authors: Marañón Pardillo
mesh_terms: D001988:Bronchiolitis / Q000150:complications* / Q000175:diagnosis*; D002648:Child; D004636:Emergency Service, Hospital; D006801:Humans; D007177:Inappropriate ADH Syndrome / Q000150:complications* / Q000175:diagnosis*; D011446:Prospective Studies
keywords: Bronchiolitis; Bronquiolitis; Children; Niños; Respiratory syncytial virus; Secreción inadecuada de hormona antidiurética; Syndrome of inappropriate antidiuretic hormone secretion; Virus respiratorio sincitial