title: Hypernatremia in Children With Diarrhea: Presenting Features, Management, Outcome, and Risk Factors for Death.
abstract: We sought to investigate the magnitude, clinical features, treatment, and outcome of children suffering from hypernatremic diarrhea and to identify risk factors for fatal outcome among them. We reviewed 2 data sets of children <15 years admitted to the in-patient ward of the Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b) with diarrhea and hypernatremia (serum sodium ≥150 mmol/L): (a) March 2001 to March 2002 (n = 371) and (b) March 2009 to August 2011 (n = 360). We reviewed their records and collected relevant information for analyses. The prevalence of hypernatremia was 5.1% (371/7212) and 2.4% (360/15 219), case fatality rate was 15% and 19%, respectively. In logistic regression analysis, the risk for death significantly increased in association with serum sodium ≥170 mmol/L, nutritional edema, hypoglycemia, respiratory distress, and absent peripheral pulses and reduced with the sole use of oral rehydration salts (ORS) or ORS following intravenous fluid, if indicated (for all, P < .05). Thus, managing children with hypernatremia using only ORS or ORS following intravenous fluid may help reduce the number of deaths.
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh chisti@icddrb.org.
authors.forename: Mohammad Jobayer
authors.initials: MJ
authors.lastname: Chisti
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Tahmeed
authors.initials: T
authors.lastname: Ahmed
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: A M Shamshir
authors.initials: AM
authors.lastname: Ahmed
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Shafiqul Alam
authors.initials: SA
authors.lastname: Sarker
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Abu Syed Golam
authors.initials: AS
authors.lastname: Faruque
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Md Munirul
authors.initials: MM
authors.lastname: Islam
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Sayeeda
authors.initials: S
authors.lastname: Huq
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Lubaba
authors.initials: L
authors.lastname: Shahrin
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Pradip Kumar
authors.initials: PK
authors.lastname: Bardhan
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Mohammed Abdus
authors.initials: MA
authors.lastname: Salam
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use; D001459:Bangladesh / Q000453:epidemiology; D015897:Comorbidity; D003968:Diarrhea, Infantile / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D006955:Hypernatremia / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D007223:Infant; D008297:Male; D010100:Oxygen / Q000627:therapeutic use; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D010100:Oxygen
keywords: children younger than 5 years; deaths; fluid resuscitation; pneumonia; severe acute malnutrition; severe sepsis