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

Au, Alicia K.; Ray, Patricio E.; McBryde, Kevin D.; Newman, Kurt D.; Weinstein, Steven L.; Bell, Michael J.

doi:10.1016/j.jpeds.2007.08.040

« Previous Next »The Journal of Pediatrics
Volume 152, Issue 1 , Pages 33-38, January 2008

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

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

Received 13 May 2007; received in revised form 13 August 2007; accepted 23 August 2007. published online 23 November 2007.

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.

Abbreviations: CI, Confidence interval, HT, Hypotonic, IV, Intravenous, NT, Normotonic, PICU, Pediatric intensive care unit

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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).

PII: S0022-3476(07)00841-4

doi:10.1016/j.jpeds.2007.08.040

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