Published: 2017-05-27

Clinical profile, etiology, management and outcome of serum sodium disturbances in children admitted in PICU

Balaji Jayakumar, Ekambaranath Sambasivam


Background: Sodium disorders are common in children who need intensive care, they occur in variety of conditions, may remain unrecognized if not suspected and monitored and result in morbidity and mortality irrespective of primary problem. The aim of the study is to know etiology, management and outcome of sodium disturbances in sick children admitted to pediatric intensive care unit to Institute of Social Pediatrics Stanley Medical College.

Methods: This is a hospital based cross sectional study. Two hundred and twenty-seven children in the age group of 1month to 12 years admitted in PICU over the period of 8 months were included in the study. Venous blood sampling is obtained from each patient enrolled in the study and is sent for estimation of electrolytes, blood urea, glucose levels. Serum osmolality (calculated), urine osmolality, urine spot sodium were done in selected patients.

Results: Among the 227 children studied, 85 children had sodium disturbances that included both hyponatremia (80 children) and hypernatremia (5 children) The most common cause of hyponatremia is CNS disorder 25 patients (31.25%) followed by poisoning 17.

Conclusions: Hyponatremia occurs frequently and should be looked for in all sick children. It is of hypotonic- euvolemic type in almost all the acute infections except diarrhea and should be managed accordingly. They contribute significantly to the mortality and morbidity.



Hyponatremia, Hypernatremia, Hypotoniceuvolemic, Sodium disorders

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Roberts KE. Fluid and electrolyte regulation. In: Curley MAQ, Moloney-Harmon PA, editors. care nursing of infants and children. 2nd ed. Philadelphia7 W.B. Saunders; 2001:369-92.

Singhi S, Prasad SVSS, Chugh KS. Hyponatremia in sick children: A marker of serious illness. Indian Pediatr. 1994;31(1):19-25.

Michael et al. Journal of critical care (2013) hypernatremia. Nelson essentials of edition. Philadelphia7 WB Saunders. 2002:671-709.

Subba Rao SD, Thomas B. Electrolyte Abnormalities in Children Admitted to Pediatric Intensive Care Unit. Indian Pediatr. 2000;37:1348-53.

Pizzotti NJ, Madi JC, Iamanaca AI, Seguro AC, Rocha AS. Hyponatremia: Study of its epidemiology and mortality. Rev Hosp Clin Fac Med. 1989;44(6):307-11.

Moritz ML, Ayus JC. Prevention of hospital-acquired hyponatremia: a case for using isotonic saline. Pediatrics. 2003;11(2):227-30.

Amini A, Schmidt MH. Syndrome of inappropriate secretion of antidiuretic hormone and hyponatremia after spinal surgery. Neurosurg Focus. 2004;16(4):E10.

Singhi S, Dhawan A. Frequency and significance of electrolyte abnormalities in pneumonia. Indian Pediatr 1994;31:735-40.

Mandal AK, Saklayan MG, Hillman NM, Market RJ. Predictive factors for high mortality in hypernatremic patients. Am J Emerg Med. 1997;15(2):130-2.

Samadi AR, Wahed MA, Islam MR, Ahmed SM. Consequences of hyponatremia and hypernatremia in children with acute diarrhea in Bangladesh. Br Med J. 1983;286(6366):671-3.