Hyponatremia among Critically Ill Children Admitted to Pediatric Intensive Care Unit (PICU)

Abstract

Background: Hyponatremia in critically ill children can lead to significant increase in morbidity and mortality. Early diagnosis followed by proper treatment can help decrease adverse events in such cases. This study was conducted to ascertain the magnitude of problem in our local population. Objective: To determine the frequency of hyponatremia among children admitted in pediatric intensive care unit (PICU).  Material and Methods: These study cases were registered from Department of Pediatrics, Nishtar Hospital, Multan which were admitted to Paediatric Intensive Care Unit (PICU). Duration of the study was 6 months from January 2017 to June 2017. Once registered in the study, three milliliters (ml) of venous blood sample was drawn. This blood sample was sent to laboratory for serum sodium level estimation. Confidentiality of the patient record was maintained.  Child was considered hyponatremic, if serum sodium (Na⁺) levels are <135 mEq/L and malnourished if weight for height/length less than -3 SD (Less than 70% of expected). All the data was entered and analyzed using SPSS-20 and mean and standard deviation for disease duration, serum sodium levels and the age of the patients were taken. Results; Of these 135 study cases, 79 (58.5%) were boys while 56 (41.5%) were girls. Mean age of our study cases was 4.31 ± 2.29 years. Multiorgan dysfunction was major cause of admission to PICU i.e. 36 (26.7%), pneumonia in 28 (20.7%), trauma in 28 (20.7%), cardiovascular diseases in 18 (13.3%), complicated gastroenteritis in 16 (11.9%) and viral bronchiolitis in 9 (6.7%). Mean disease duration was 8.16 ± 4.62 days. Of these 135 study cases, 38 (28.1%) were malnourished and 92 (68.1%) had history of hypotonic IV fluid therapy. Mean stay at PICU was 6.92 ± 4.11 days. Mean Serum Sodium level was 134.46 ± 3.23 mEq/L (with minimum serum sodium level was 130 mEq/L while maximum level was 140 mEq/L). Hyponatremia was noted in 61 (45.2%) of our study cases. Conclusion: Frequency of hyponatremia was high in our study which was significantly associated with gender, disease duration, cause of admission, nutritional status and use of hypotonic IV fluid therapy. Hyponatremia was significantly associated with prolonged duration of hospitalization in pediatric intensive care unit which exerts extra burden on hospital authorities. Timely diagnosis and correction of hyponatremia can lead to decrease disease morbidity and duration of hospitalization.

Keywords: Hyponatremia, pediatric intensive care unit, frequency.