title: Na(+), K(+), Cl(-), acid-base or H2O homeostasis in children with urinary tract infections: a narrative review.
abstract: Guidelines on the diagnosis and management of urinary tract infections in childhood do not address the issue of abnormalities in Na(+), K(+), Cl(-) and acid-base balance. We have conducted a narrative review of the literature with the aim to describe the underlying mechanisms of these abnormalities and to suggest therapeutic maneuvers. Abnormalities in Na(+), K(+), Cl(-) and acid-base balance are common in newborns and infants and uncommon in children of more than 3 years of age. Such abnormalities may result from factitious laboratory results, from signs and symptoms (such as excessive sweating, poor fluid intake, vomiting and passage of loose stools) of the infection itself, from a renal dysfunction, from improper parenteral fluid management or from the prescribed antimicrobials. In addition, two transient renal tubular dysfunctions may occur in infants with infectious renal parenchymal involvement: a reduced capacity to concentrate urine and pseudohypoaldosteronism secondary to renal tubular unresponsiveness to aldosterone that presents with hyponatremia, hyperkalemia and acidosis. In addition to antimicrobials, volume resuscitation with an isotonic solution is required in these children. In secondary pseudohypoaldosteronism, isotonic solutions (such as 0.9 % saline or lactated Ringer) correct not only the volume depletion but also the hyperkalemia and acidosis. In conclusion, our review suggests that in infants with infectious renal parenchymal involvement, non-renal and renal causes concur to cause fluid volume depletion and abnormalities in electrolyte and acid-base balance, most frequently hyponatremia.
authors.affiliation: Pediatric Department of Southern Switzerland, 6500, Bellinzona, Switzerland.
authors.forename: Anna
authors.initials: A
authors.lastname: Bertini
authors.affiliation: Pediatric Emergency Department, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Gregorio P
authors.initials: GP
authors.lastname: Milani
authors.affiliation: Pediatric Department of Southern Switzerland, 6500, Bellinzona, Switzerland.|University Children's Hospital Bern-University of Bern, 3010, Bern, Switzerland.
authors.forename: Giacomo D
authors.initials: GD
authors.lastname: Simonetti
authors.affiliation: Pediatric Emergency Department, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Emilio F
authors.initials: EF
authors.lastname: Fossali
authors.affiliation: Department of Internal Medicine, Ospedale San Giovanni, Bellinzona, Switzerland.
authors.forename: Pietro B
authors.initials: PB
authors.lastname: Faré
authors.affiliation: Pediatric Department of Southern Switzerland, 6500, Bellinzona, Switzerland.
authors.forename: Mario G
authors.initials: MG
authors.lastname: Bianchetti
authors.affiliation: Pediatric Department of Southern Switzerland, 6500, Bellinzona, Switzerland. sebastiano.lava@bluewin.ch.|University Children's Hospital Bern-University of Bern, 3010, Bern, Switzerland. sebastiano.lava@bluewin.ch.
authors.forename: Sebastiano A G
authors.initials: SA
authors.lastname: Lava
mesh_terms: D002648:Child; D002675:Child, Preschool; D006801:Humans; D006947:Hyperkalemia; D007010:Hyponatremia; D007223:Infant; D007231:Infant, Newborn; D011546:Pseudohypoaldosteronism; D012964:Sodium; D014552:Urinary Tract Infections / Q000503:physiopathology*
chemical_list: D012964:Sodium
keywords: Acidosis; Childhood; Electrolytes; Hyperkalemia; Hyponatremia; Pseudohypoaldosteronism; Urinary tract infection