Clinical Analysis Of Hyponatremia In Critically Ill Children

Objective: The aim of the study was to investigate the prevalence and clinical features of hyponatremia on admission in PICU hospitalized patients,to investigate the underlying causes,clinical manifestations,treatment and prognosis of hyponatremia?Prompt recognition of patients with hyponatremic is critical in order to provide immediate therapy.Methods:A retrospective analysis of children with hyponatremia aged 29 days to 14 years old,admitted to PICU of Shengjing Hospital affiliated from January 1,2018 to December 31,2018.According to the sodium concentration on the admission day and different primary disease groups,the general condition,clinical symptoms,nervous system performance,treatment and outcome were recorded.The corresponding statistical methods were used to compare the general clinical data of different blood sodium levels.To analyze the distribution of primary diseases in each group and common causes,the relationship between hyponatremia and the severity of the disease,treatment and its predictive value for prognosis.Results: 1.A total of 1005 critically ill children with complete baseline data were enrolled and the prevalence of hyponatremia on admission was 30.4 %(306/1005),including 188 males(188/306,61.4%)and 118 females(118/306,38.6%).There was no significant difference in the age,sex of patients with the severity of hyponatremia(both P>0.05).Mild,moderate,and severe hyponatremia were 113(36.9%),122(39.9%),and 71(23.2%),respectively,and most patients with hyponatremia were moderate.There were differences in age between children with different degrees of severe hyponatremia(p<0.05).The younger the age,the more severe the hyponatremia.Children with serum sodium <125mmol/L were age-related and had no relationship with all-case mortality.2.The moderate and severe hyponatremia group was associated with hypokalemia,hypoalbuminemia,hyperglycemia and hypercreatineemia(p<0.05).87 patients(28.4%)had hyperglycemia and 12 patients(3.9%)had hypoglycemia.3.Children with shock and sepsis were more likely to have moderate or severe hyponatremia(p<0.05).The incidence of respiratory failure(ie,nasal catheterization and mechanical ventilation)was 44.8%(137/306),which were more likely to havemoderate or severe hyponatremia(p<0.05).62.1% of children with hyponatremia had a history of fever(p<0.05).There were drowsiness and coma in 20.9% of the children,and convulsions occurred in 50.3%,the prognosis of children have convulsions is not related to the degree of sodium reduction at admission(p>0.05).Compared with children in other disease groups,25.1%(61/243) is hyponatremia encephalopathy.Which was younger,had lower blood sodium levels,and responded better to sodium ion correction therapy,and more accompanied with respiratory failure ? shock.?hypokalemia,the average hospital stay was longer(p <0.05).There was a difference in the distribution of primary disease in children with different level of hyponatremia,and the proportion of severe hyponatremia in the initial diagnosis of sepsis was higher(p<0.05).4.A total of 81.5%(248/306)of patients underwent Na supplementation therapy,of which 66.1%(164/248) had an effect.In the severe group,sodium increased13mmol/L after therapy.Among 306 children with hyponatremia,182(59.5%)improved,and 15(4.9%) died.The prognosis of children with moderate or severe hyponatremia was poor.the mortality rate increased(p<0.05).Conclusion: Critically ill children often have hyponatremia on admission,and their prevalence is as high as 30.4%.Acute central nervous system diseases,respiratory diseases and digestive tract diseases are common primary diseases of hyponatremia.Hyponatremia is associated with clinical symptoms and organ dysfunction,as well as hyponatremia encephalopathy;timely and effective correction of hyponatremia is important,which can significantly shorten the treatment time of children,improve the cure rate and improve the prognosis.