This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Web of Science (48)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Hoorn, E. J.
Right arrow Articles by Bohn, D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Hoorn, E. J.
Right arrow Articles by Bohn, D.
Related Collections
Right arrow Nutrition & Metabolism
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?
PEDIATRICS Vol. 113 No. 5 May 2004, pp. 1279-1284

Acute Hyponatremia Related to Intravenous Fluid Administration in Hospitalized Children: An Observational Study

Ewout J. Hoorn, MD*, Denis Geary, MB{ddagger},§, Maryanne Robb, MD{ddagger},§,||, Mitchell L. Halperin, MD and Desmond Bohn, MB*,#

* Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
{ddagger} Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
§ Department of Pediatrics, University of Toronto, Toronto, Canada
|| Department of Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
Renal Division, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
# Department of Anesthesia, University of Toronto, Toronto, Canada

Objective. To develop hyponatremia (plasma sodium concentration [PNa] <136 mmol/L), one needs a source of water input and antidiuretic hormone secretion release to diminish its excretion. The administration of hypotonic maintenance fluids is common practice in hospitalized children. The objective of this study was to identify risk factors for the development of hospital-acquired, acute hyponatremia in a tertiary care hospital using a retrospective analysis.

Methods. All children who presented to the emergency department in a 3-month period and had at least 1 PNa measured (n = 1586) were evaluated. Those who were admitted were followed for the next 48 hours to identify patients with hospital-acquired hyponatremia. An age- and gender-matched case-control (1:3) analysis was performed with patients who did not become hyponatremic.

Results. Hyponatremia (PNa <136 mmol/L) was documented in 131 of 1586 patients with ≥1 PNa measurements. Although 96 patients were hyponatremic on presentation, our study group consisted of 40 patients who developed hyponatremia in hospital. The case-control study showed that the patients in the hospital-acquired hyponatremia group received significantly more EFW and had a higher positive water balance. With respect to outcomes, 2 patients had major neurologic sequelae and 1 died.

Conclusion. The most important factor for hospital-acquired hyponatremia is the administration of hypotonic fluid. We suggest that hypotonic fluid not be given to children when they have a PNa <138 mmol/L.

Key Words: antidiuretic hormone • concentration of the urine • electrolyte-free water • intravenous fluids

Abbreviations: ECF, extracellular fluid • ADH, antidiuretic hormone secretion • PNa, plasma sodium concentration • EFW, electrolyte-free water • TBW, total body water

Received for publication Mar 24, 2003; Accepted Aug 19, 2003.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 AAP Grand RoundsHome page
L. A. Greenbaum
Hyponatremia in Children With Pneumonia
AAP Grand Rounds, March 1, 2009; 21(3): 31 - 31.
[Full Text] [PDF]

Home page
 Nephrol Dial TransplantHome page
E. J. Hoorn, M. G.H. Betjes, J. Weigel, and R. Zietse
Hypernatraemia in critically ill patients: too little water and too much salt
Nephrol. Dial. Transplant., May 1, 2008; 23(5): 1562 - 1568.
[Abstract] [Full Text] [PDF]

Home page
 Arch. Dis. Child.Home page
K Armon, A Riordan, S Playfor, G Millman, A Khader, and for the Paediatric Research Society
Hyponatraemia and hypokalaemia during intravenous fluid administration
Arch. Dis. Child., April 1, 2008; 93(4): 285 - 287.
[Abstract] [Full Text] [PDF]

Home page
 CLIN PEDIATRHome page
C. E. Beck
Hypotonic Versus Isotonic Maintenance Intravenous Fluid Therapy in Hospitalized Children: A Systematic Review
Clinical Pediatrics, December 1, 2007; 46(9): 764 - 770.
[Abstract] [PDF]

Home page
 Arch. Dis. Child.Home page
M Sanchez-Bayle, A Alonso-Ojembarrena, and J Cano-Fernandez
Intravenous rehydration of children with gastroenteritis: which solution is better?
Arch. Dis. Child., August 1, 2007; 92(8): 735 - 735.
[Full Text] [PDF]

Home page
 Arch. Dis. Child.Home page
M. A Holliday, P. E Ray, and A. L Friedman
Fluid therapy for children: facts, fashions and questions
Arch. Dis. Child., June 1, 2007; 92(6): 546 - 550.
[Abstract] [Full Text] [PDF]

Home page
 Arch. Dis. Child.Home page
K Choong, M E Kho, K Menon, and D Bohn
Hypotonic versus isotonic saline in hospitalised children: a systematic review
Arch. Dis. Child., October 1, 2006; 91(10): 828 - 835.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
M. Cunliffe and F. Potter
Four and a fifth and all that.
Br. J. Anaesth., September 1, 2006; 97(3): 274 - 277.
[Full Text] [PDF]

Home page
 Br J AnaesthHome page
C. Way, R. Dhamrait, A. Wade, and I. Walker
Perioperative fluid therapy in children: a survey of current prescribing practice
Br. J. Anaesth., September 1, 2006; 97(3): 371 - 379.
[Abstract] [Full Text] [PDF]

Home page
 Arch. Dis. Child.Home page
M Sanchez-Bayle, A Alonso-Ojembarrena, and J Cano-Fernandez
Intravenous rehydration of children with gastroenteritis: which solution is better?
Arch. Dis. Child., August 1, 2006; 91(8): 716 - 716.
[Full Text] [PDF]

Home page
 CLIN PEDIATRHome page
K. McCormick
Diagnosis: Bronchiolitis with SIADH
Clinical Pediatrics, January 1, 2006; 45(1): 102 - 103.
[PDF]

Home page
 Nephrol Dial TransplantHome page
E. J. Hoorn, J. Lindemans, and R. Zietse
Development of severe hyponatraemia in hospitalized patients: treatment-related risk factors and inadequate management
Nephrol. Dial. Transplant., January 1, 2006; 21(1): 70 - 76.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
E. J. Hoorn, M. L. Halperin, and D. Bohn
Isotonic Saline Expands Extracellular Fluid and Is Inappropriate for Maintenance Therapy: In Reply
Pediatrics, January 1, 2005; 115(1): 194 - 194.
[Full Text] [PDF]

Home page
 PediatricsHome page
M. A. Holliday
Isotonic Saline Expands Extracellular Fluid and Is Inappropriate for Maintenance Therapy
Pediatrics, January 1, 2005; 115(1): 193 - 194.
[Full Text] [PDF]

Home page
 PediatricsHome page
L. Finberg
Hospital-Acquired Hyponatremia
Pediatrics, December 1, 2004; 114(6): 1741 - 1741.
[Full Text] [PDF]

Home page
 PediatricsHome page
D. Bohn, E. Hoorn, and M. L Halperin
Hospital-Acquired Hyponatremia Is Associated With Excessive Administration of Intravenous Maintenance Fluid: In Reply
Pediatrics, December 1, 2004; 114(6): 1744 - 1745.
[Full Text] [PDF]

Home page
 PediatricsHome page
K. B. Roberts
Hospital-Acquired Hyponatremia Is Associated With Excessive Administration of Intravenous Maintenance Fluid
Pediatrics, December 1, 2004; 114(6): 1743 - 1744.
[Full Text] [PDF]

Home page
 PediatricsHome page
M. Hatherill, Z. Waggie, S. Salie, and A. Argent
Hospital-Acquired Hyponatremia Is Associated With Excessive Administration of Intravenous Maintenance Fluid
Pediatrics, November 1, 2004; 114(5): 1368 - 1368.
[Full Text] [PDF]

Home page
 PediatricsHome page
M. L. Moritz and C. Ayus
Hospital-Acquired Hyponatremia Is Associated With Excessive Administration of Intravenous Maintenance Fluid: In Reply
Pediatrics, November 1, 2004; 114(5): 1368 - 1369.
[Full Text] [PDF]