Incidence of Postoperative Hyponatremia and Complications in Critically-Ill Children Treated with Hypotonic and Normotonic Solutions - 07/03/14

Doi : 10.1016/j.jpeds.2007.08.040

Alicia K. Au, MD ^a, Patricio E. Ray, MD ^a,^b,^f, Kevin D. McBryde, MD ^a,^b,^f, Kurt D. Newman, MD ^c, Steven L. Weinstein, MD ^a,^d, Michael J. Bell, MD ^a,^e,^f,^⁎
^a Department of Pediatrics, Children’s National Medical Center, Washington, DC
^b Division of Nephrology, Children’s National Medical Center, Washington, DC
^c Center for Surgical Care, Children’s National Medical Center, Washington, DC
^d Department of Neurology, Children’s National Medical Center, Washington, DC
^e Division of Critical Care Medicine, Children’s National Medical Center, Washington, DC
^f Children’s Research Institute, Children’s National Medical Center, Washington, DC.

Reprint requests: Michael J. Bell, MD, Pediatric Critical Care Medicine, Children’s Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213.

Résumé

Objective

To determine the incidence and clinical consequences of postoperative hyponatremia in children.

Study design

We performed a retrospective analysis of postoperative admissions to the pediatric intensive care unit (excluding cardiac, neurosurgical, and renal). The incidence of severe (serum sodium < 125 mmol/L or symptoms) and moderate (serum sodium < 130 mmol/L) hyponatremia in children receiving hypotonic (HT) and normotonic (NT) fluids was calculated.

Results

Out of a total of 145 children (568 sodium measurements; 116 HT and 29 NT), we identified 16 with hyponatremia (11%). The incidences of moderate (10.3% vs 3.4%, P = .258) and severe (2.6% vs 0%; P = .881) hyponatremia were not significantly different in the HT and NT groups. There were no neurologic sequelae or deaths related to hyponatremia.

Conclusions

In our study group, hyponatremia was common, but morbidity and death were not observed. Careful monitoring of serum sodium level may be responsible for this lack of adverse outcomes. Larger, prospective studies are needed to determine whether the incidence of hyponatremia differs between the HT and NT groups.

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Abbreviations : CI, HT, IV, NT, PICU

Plan

Methods

Patient Selection

Study Design and Definitions

Statistical Analysis

Results

Postoperative Period

Intraoperative Period

Preoperative Period

Discussion

Supported by grants DK4919 and HL55605 (to P.R.), a CHRC K–12 award (to K.M.), and grant HD044716 from the National Institute of Health, and a grant from United Cerebral Palsy (to M.B).

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Vol 152 - N° 1

P. 33-38 - janvier 2008 Retour au numéro

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Incidence of Postoperative Hyponatremia and Complications in Critically-Ill Children Treated with Hypotonic and Normotonic Solutions - 07/03/14

Résumé

Objective

Study design

Results

Conclusions

Plan

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