Iatrogenic hyponatremia in hospitalized children: Can it be avoided?
ABSTRACT Iatrogenic hyponatremia in hospitalized children is a common problem. It is usually caused by the administration of free water, either orally or through the prescription of hypotonic intravenous fluids. It can result in cerebral edema and death, and is most commonly reported in healthy children undergoing minor surgery. The current teachings and practical guidelines for maintenance fluid infusions are based on caloric expenditure data in healthy children that were derived and published more than 50 years ago. A re-evaluation of these data and more recent recognition that hospitalized children are vulnerable to hyponatremia, with its resulting morbidity and mortality rates, suggest that changes in paediatricians' approach to fluid administration are necessary. There is no single fluid therapy that is optimal for all hospitalized children. A thorough assessment of the type of fluid, volume of fluid and electrolyte requirements based on individual patient requirements, plus rigorous monitoring, is required in any child receiving intravenous fluids. The present article reviews how hyponatremia occurs and makes recommendations for minimizing the risk of iatrogenic hyponatremia.
Pediatrics 09/1998; 102(2 Pt 1):399-400. · 5.44 Impact Factor
Electrophoresis 08/2000; 21(12):2582-3. · 3.30 Impact Factor
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ABSTRACT: Serum sodium concentrations were measured in 93 children with pneumonia or bacterial meningitis on their admission to hospital. Hyponatraemia (sodium value 134 mmol/l or less) was present in 33 (45%) of the 73 children with pneumonia, and in 10 (50%) of the 20 children with bacterial meningitis. Increased secretion of antidiuretic hormone is common in children with pneumonia, as well as in children with meningitis. The maintenance fluid requirement in these children is usually about 50 ml/kg/per day, and children with hyponatraemia caused by water overload need even lower fluid intakes. In developing countries, most children with pneumonia and meningitis should be managed without intravenous fluid treatment.Archives of Disease in Childhood 11/1985; 60(10):963-6. · 2.88 Impact Factor