Hyponatremia Linked to Severe Adverse Outcomes in Children

Topline: 

Mild hyponatremia in children visiting pediatric emergency departments (PEDs) is associated with higher rates of vasopressor use, ward and pediatric intensive care unit (PICU) admissions, and mortality, with these adverse events increasing with increased hyponatremia severity.

Methodology:

• This single-center retrospective study investigated the relationship between hyponatremia severity and adverse outcomes among children in a PED from January 1, 2009, to December 31, 2020. 
• Of the 44,147 pediatric patients studied, 1639 (3.7%) had hyponatremia, with 1521 (3.4%) experiencing mild hyponatremia (serum sodium concentration
• The study outcomes were vasopressor use, admission to a ward or PICU, and mortality. 

Takeaway:

• Ward admission rates were higher in the mild hyponatremia group than in the normonatremia group (51.1% vs 35.6%; P <.001>
• Vasopressor use and PICU admission rates were 1.1% and 2.4%, respectively, in the mild hyponatremia group, which were significantly higher than the corresponding rates of 0.6% and 0.9% in the normonatremia group (P =.014 and P <.001>
• The mild hyponatremia group exhibited a significantly higher mortality rate of 1.5% than the normonatremia group, which had a corresponding rate of 0.3% (P <.001>
• Rates of vasopressor use, PICU admissions, and mortality increased significantly from the normonatremia to severe hyponatremia groups. 

In Practice: 

“Immediate intervention should be implemented in addition to identifying the cause [of mild hyponatremia]. These interventions are crucial for improving adverse outcomes and patient care in the emergency department setting,” the authors wrote.

Source: 

This study was led by Jisu Ryoo from the Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. It was published online on June 14, 2024, in Frontiers in Pediatrics.

Limitations: 

The study’s retrospective design and reliance on data from a single institution’s electronic medical records may limit its generalizability to all PED visits. Additionally, the use of anonymous data means that multiple entries for the same patient may have been included.

Disclosures: 

The study received financial support from the Catholic Medical Center Research Foundation. The authors reported no conflicts of interest.