Hospital-acquired hyponatremia in children: Epidemiology, pathophysiology, and prevention

Abstract

Recent observations have revealed that otherwise healthy children with acute illnesses are prone to hyponatremia due to increased arginine vasopressin production by non-osmotic stimuli. Concern has recently been raised about the potential for iatrogenic hyponatremia as a result of maintenance fluid therapy for those children. To minimize the risk of development of hospital-acquired hyponatremia in sick children receiving maintenance fluid therapy, the routine practice of administration of hypotonic fluids (e.g., 0.18% NaCl with 4% glucose: Na 31 mEq/L, Cl 31 mEq/L) should be abandoned. Instead, isotonic solution, such as 0.9% NaCl (Na 154 mEq/L, K 0 mEq/L, Cl 154 mEq/L) or Hartmann's solution (Na 130 mEq/L, K 4 mEq/L, Cl 110 mEq/L) should be administered. In addition, it must be noted that close monitoring of the children with daily weights, frequent vitals, strict intake and output measurement, and daily chemistries, especially during the first 72 h of parenteral fluid therapy is essential.

Keywords

Hospital-acquired hyponatremia - maintenance fluid therapy - hypotonic fluid - saline - Hartmann's solution