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| |  Hypotonic Fluid Therapy Can Cause Hyponatraemia in Children Hospitalised With Gastroenteritis and Dehydration: Presented at NKF By Deborah Brauser NASHVILLE, Tenn -- March 30, 2009 -- Treating children with both gastroenteritis and dehydration using hypotonic fluids can lead to mild hyponatraemia, according to research from a retrospective study presented here at the National Kidney Foundation (NKF) 2009 Spring Clinical Meetings. The results were reported in a poster presentation on March 26 by Mina Hanna, MD, St. Louis Children's Hospital, St. Louis, Missouri. Though hypotonic saline solution is a common treatment for children with diarrhoeal dehydration, there's been concern about potential risks of iatrogenic hyponatraemia. To measure the incidence and severity of acquired hyponatraemia in children admitted to the hospital with acute gastroenteritis and isotonic dehydration, Dr. Hanna and colleagues reviewed the medical records of 124 previously healthy children who had at least 2 serum sodium (Na) measurements -- one on admission and another after 4 to 24 hours (mean 13.2 hours) of intravenous hypotonic fluid (5% dextrose [D5] in 0.2%, in 0.3%, or in 0.45% saline) therapy. Of the overall group, 82% were on D5 0.3% saline, 15% on D5 0.45% saline, and 3% D5 0.2% saline. Children were 1 month to 12 years old (mean age 3.3 years). Overall, results showed that patients treated with hydration had a significant increase in weight of 0.2 kg, an increase in CO2 of 2.3 mmol/L, a decrease in Na of 1.7 mEq/L, a decrease in blood urea nitrogen of 7.9 mg/dL, and a decrease in creatinine level of 0.5 mg/dL (paired t test P < .01 for all). Of the 97 patients admitted with isonatraemia (Na 135-145 mEq/L, mean 140.1 +- 2.7), 79 (81.4%) remained isonatraemic and 18 (18.6%) became hyponatraemic (Na 133.4 mEq/L) after hydration. The decrease in serum Na (-5.7 mEq/L) was significantly higher (P < .002) in patients who became hyponatraemic than in those who remained normonatraemic (-1.8 mEq/L). None of these patients developed symptoms of hyponatraemia. The 18 isonatraemic patients who became hyponatraemic after fluid therapy were older than those who remained isonatraemic (5.8 vs 2.8 years; P < .0005). A total of 19 patients were hyponatraemic at admission, with a serum Na level of 130 to 134 mEq/L (mean 132.8). Of these, 14 (73%) became isonatraemic (mean Na 136.7 mEq/L) with an increase of 3.9 mEq/L after hypotonic fluid therapy, and 5 remained hyponatraemic. "The use of hypotonic fluids in kids can cause hyponatraemia," said Dr. Hanna. "In my study, the kids who developed hyponatraemia did not have complications, but there have been other reports of hyponatraemia causing seizures. So if [hypotonic fluid therapy is] going to be used for a long time, then it needs to be monitored closely." "There have been 2 other studies that have looked at this," continued Dr. Hanna. "The one in 2004 showed an incidence of about 9% and the second one in 2008 had an incidence of about 11%. Mine had an incidence of about 15%." This difference was probably due to the fact that his study focused on children with gastroenteritis and dehydration, he explained, "which is probably the most common reason for hypotonic fluids being used in kids today."
[Presentation title: Hypotonic Fluid Therapy Induced Hyponatremia in Hospitalized Children With Gastroenteritis and Dehydration. Abstract 71]
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