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Category: Volume 07 Issue 06 June 2019
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Title: Impact of Hyponatremia on Clinical Presentation and Management in Pediatric Patients with lower Respiratory Infections

Authors: Dr Harmohinder Kumar Attri, Dr Tejinder Singh, Dr Vandana, Dr Garima Sehgal, Dr Kuldeep Kumar

 DOI: https://dx.doi.org/10.18535/jmscr/v7i6.05

Abstract

Objectives: The purpose of this study was to characterize the impact of hyponatremiaon clinical presentation and management in pediatric patients suffering from lower respiratory infection within 2 hours of admission in ICU and to investigate whether there is link between hyponatremia and the severity and outcome of LRIs.

Methods: 100 pediatric patients of age group 2months to 5 years suffering from lower respiratory infections were recruited in the study. Clinical presentation and chest X ray were recorded. Serum sodium levels were assessed to diagnose Hyponatremia (s. sodium<135mEq/L). Appropriate fluid therapy was administered to each patient and impact of hyponatremia over isonatremia was evaluated in patients.

Results: 75 were in the age group of 2months to 1year and 25 were in the age group of 1 to 5 years. 63 children had normal sodium levels (Isonatremia) and 33 children had hyponatremiaat the time of admission. Association of clinical symptoms and signs in isonatremic versus hyponatremic patients were not found significant statistically in both age groups (p >0.05). It was evident from these observation that abnormal x ray findings were more common in the hyponatremic cases (p=0.008) than the isonatremic cases (p<0.001). Association of requirement of i/v fluids in hyponatremic versus isonatremic patients was found to be significant statistically in both age groups (p value 0.000).

Conclusion: Thus it is concluded that, presence of hyponatremia in LRI’s increases the morbidity of these patients as radiographic findings were more common. Therefore, fluid therapy is required more in Hyponatremic patients.

References

  1. Chaitra KM. Hyponatremia in lower respiratory tract infections. International Journal of Contemporary Pediatrics. 2016;3(2):381-4.
  2. Lussky HO, Friedstein H. Water retention in pneumonia. American Journal of Diseases of Children. 1920;19(5):337-43.
  3. Upadhyay A, Jaber BL, Madias NE. Incidence and prevalence of hyponatremia. The American Journal of Medicine. 2006;119(7):S30-5.
  4. Eisenhut M. Extrapulmonary manifestations of severe respiratory syncytial virus infection–a systematic review. Critical Care. 2006;10(4): R107.
  5. Sharples PM, Seckl JR, Human D, Lightman SL, Dunger DB. Plasma and cerebrospinal fluid arginine vasopressin in patients with and without fever. Archives of Disease in Childhood. 1992;67(8):998-1002.
  6. Watanabe T, Abe Y, Sato S, Uehara Y, Ikeno K, Abe T. Hyponatremia in Kawasaki disease. Pediatric Nephrology. 2006;21(6):778-81.
  7. Van Steensel-Moll HA, Hazelzet JA, van der Voort E, Neijens HJ, Hackeng WH. Excessive secretion of antidiuretic hormone in infections with respiratory syncytial virus. Archives of Disease in Childhood. 1990; 65(11):1237-9
  8. Szabo FK, Lomenick JP. Syndrome of inappropriate antidiuretic hormone secretion in an infant with respiratory syncytial virus bronchiolitis. Clinical Pediatrics. 2008;47(8):840-2.
  9. Nair V, Niederman MS, Masani N, Fishbane S. Hyponatremia in community-acquired pneumonia. American Journal of Nephrology. 2007;27(2):184-90.
  10. Greenbaum LA. Hypervitaminosis D. In: Kliegman RM, Stanton BF, Geme JW, Schor NF, Behrman RE (eds). Nelson Textbook of Pediatrics.
  11. Principi N, Esposito S. Management of severe community-acquired pneumonia of children in developing and developed countries. Thorax. 2011;66(9):815-22.
  12. Sorensen JB, Andersen MK, Hansen HH. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in malignant disease. Journal of Internal Medicine. 1995;238(2):97-110.
  13. Gross P. Clinical management of SIADH. Therapeutic advances in Endocrinology and Metabolism. 2012;3(2):61-73.
  14. Chhina AS, Iyer CR, Gornale VK, Katwe N, Sushma S, Harsha PJ. Clinical profile of acute lower respiratory tract infections in children between 2 months to 5 years. J Evidence Based Med Healthcare. 2015;2(35):5426-31.
  15. Don M, Valerio G, Korppi M, Canciani M. Hyponatremia in pediatric community-acquired pneumonia. Pediatric nephrology. 2008 Dec 1;23(12):2247-53.
  16. Singhi S, Dhawan A. Frequency and significance of electrolyte abnormalities in pneumonia. Indian Pediatrics. 1992;29 (6):735-40.
  17. Dhawan A, Narang A, Singhi S. Hyponatraemia and the inappropriate ADH syndrome in pneumonia. Annals of Tropical Paediatrics. 1992;12(4):455-62.
  18. Sakellaropoulou A, Hatzistilianou M, Eboriadou M, Athanasiadou-Piperopoulou F. Hyponatraemia in cases of children with pneumonia. Archives of medical science: AMS. 2010;6(4):578.
  19. Channawar KS, Deshmukh N, Prasad VS. Correlation of hyponatraemia in children with lower respiratory tract infection--an institutional observational study. Journal of Evolution of Medical and Dental Sciences. 2016;5(88):6533-6.
  20. Don M, Valerio G, Korppi M, Canciani M. Hyponatremia in pediatric community-acquired pneumonia. Pediatric Nephrology. 2008;23(12): 2247-53.
  21. Rahul V, Jose O. Prevalence of Hyponatremia in Children with Pneumonia-Cross-Sectional Study. Journal of Dental and Medical Sciences 2017; 16(3):46-50.
  22. Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H. Epidemiology and etiology of childhood pneumonia. Bulletin of the World Health Organization. 2008;86:408-16B.
  23. Unicef W. Pneumonia: the forgotten killer of children. UNICEF/WHO. 2006;140.

Corresponding Author

Dr Tejinder Singh

Senior Resident, Department of Biochemistry, Govt. Medical College, Amritsar, India