Hyponatremic encephalopathy
Abstract
Introduction: hyponatremia is the most common electrolytic abnormality in hospitalized patients. It is related to the administration of hypotonic fluids in patients with high levels of antidiuretic hormone. The most serious complication of hyponatremia is hyponatremic encephalopathy which can be fatal, or cause irreversible brain damage if not treated properly.Case presentation: a 6-month-old, eutrophic infant with health history and psychomotor development according to her age that was admitted in the Pediatric Hospital of Cienfuegos with the diagnosis of an acute diarrheal disease by rotavirus. It was decided to suspend the feeding and initiate maintenance hydration due to intolerance in the oral route. A solution based on 5 % dextrose with 0.18 % of NaCl was used. After 14 hours in the ward, the patient was transferred to Intensive Care due to convulsions, which were related to severe hyponatremia. Initially the sodium value was normal. The cranial tomography performed 13 days later showed signs of cortical atrophy. At the time of doing this work the girl was being followed in consultation of Physiatry and Neuropediatrics by a flabby quadriparesia.
Conclusions: hypotonic fluids are still recommended as maintenance fluids in acutely ill patients, despite the strong association among their use and the development of hyponatremia. It is time to stop using hypotonic fluids in disease states associated with excess of antidiuretic hormone, because there is no reason for this practice to continue.
Downloads
References
1.- Moritz M L, Ayus J C. Maintenance Intravenous Fluids in Acutely Ill Patients. N Engl J Med [Internet]. 2015 Oct [cited March 8 2017]; 373(14): [Above 11p.]. Available from: http://www.nejm.org/doi/pdf/10.1056/NEJMra1412877
2.-Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol [Internet]. 2014 Feb [cited March 6 2017]; 17(1): [Above 47p.]. Available from: http://www.eje-online.org/content/170/3/G1.long
3.- Nagler E V, Vanmassenhove J, van der Veer S N, Nistor I, Van Biesen W, Webster A C, Vanholder R. Diagnosis and treatment of hyponatremia: a systematic review of clinical practice guidelines and consensus statements. BMC Medicine [Internet]. 2014 [cited March 7 2017]; 12(1): [Above 16p.]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4276109/pdf/12916_2014_Article_231.pdf
4.- Verbalis J G, Goldsmith S R, Greenberg A, Korzelius C, Schrier R W, Sterns R H et al. Diagnosis, Evaluation, and Treatment of Hyponatremia: Expert Panel Recommendations. Am J Med [Internet]. 2013 Oct [cited March 7 2017]; 126(10 Suppl 1): [Above 42p.]. Available from: http://ac.els-cdn.com/S0002934313006050/1-s2.0-S0002934313006050-main.pdf?_tid=1d4e3b9e-0347-11e7-ad38-00000aacb361&acdnat=1488899142_003859f4cfb335e47507e8a95b0fb963
5.- Flores Robles CM, Cuello García CA..A prospective trial comparing isotonic with hypotonic maintenance fluids for prevention of hospital-acquired hyponatraemia. PaediatrInt Child Health [Internet]. 2016 Aug [cited March 3 2017]; 36(3): [Above 7p.]. Available from:
http://www.tandfonline.com/doi/pdf/10.1179/2046905515Y.0000000047
6.- Padua A P, Macaraya J R, Dans L F, Anacleto Jr. F E . Isotonic versus hypotonic saline solution for maintenance intravenous fluid therapy in children: a systematic review. PediatrNephrol [Internet]. 2015 [cited March 7 2017] 30: [Above 10p.]. Available from: http://link.springer.com/article/10.1007%2Fs00467-014-3033-y
7.- Moritz M L, Ayus J C. Management of hyponatremia in Various Clinical Situations. Curr Treat Options Neurol [Internet]. 2014 [cited March 8 2017]; 16: 310. [Above 14p.]. Available from: http://link.springer.com/article/10.1007%2Fs11940-014-0310-9
8.- Moritz M L, Ayus J C. Hyponatraemia. Isotonic fluids prevent hospital-acquired hyponatraemia. Nature Reviews Nephrology [Internet]. 2015 April [cited March 3 2017]; 11: [Above 2p.]. Available from: http://www.nature.com/nrneph/journal/v11/n4/pdf/nrneph.2014.253.pdf
9.-McNab S, Duke T, South M, Babl F E, Lee K J, Arnup S J et al.140 mmol/l of sodium versus 77 mmol/l of sodium in maintenance intravenous fluid therapy for children in hospital (PIMS): a randomised controlled double-blind trial. Lancet [Internet]. 2014 Nov [cited March 3 2017]; 385(9974): [Above 8p.]. Available from: http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736%2814%2961459-8.pdf
10.- Toledo J D, Morell C, Vento M. Intravenous isotonic fluids induced a positive trend in natraemia in children admitted to a general pediatric ward. ActaPediatrica [Internet]. 2016 [cited March 7 2017]; 105(6): [aprox.6p.]. Available from: http://onlinelibrary.wiley.com/doi/10.1111/apa.13316/full
11.- Rey C, Los-Arcos M, Hernández A, Sánchez A, Díaz J J, López-Herce J. Hypotonic versus isotonic maintenance fluids in critically ill children: a multicenter prospective randomized study. ActaPediatrica [Internet]. 2011 Mar [cited March 7 2017]; 100(8): [Above 6p.]. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.2011.02209.x/full
12.- Lee J M, Jung Y, Lee S E, Lee J H, Kim K H, Koo J W et al. Intravenous fluid prescription practices among pediatric residents in Korea. Korean Journal of Pediatrics [Internet]. 2013 Jul [cited March 7 2017];56(7): [Above 4p.]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3728446/pdf/kjped-56-282.pdf
13.- McNab S. Intravenous maintenance fluid therapy in children. Journal of Paediatrics and Child Health [Internet]. 2016 Apr [cited March 7 2017]; 52(2): [Above 4p]. Available from: http://onlinelibrary.wiley.com/doi/10.1111/jpc.13076/pdf
14.- Wang J, Xu E, Xiao Y. Isotonic Versus Hypotonic Maintenance IV Fluids in
Hospitalized Children: A Meta-Analysis. PEDIATRICS [Internet]. 2014 Jan [cited March 7 2017]; 133(1): [Above 11p.]. Available from: http://pediatrics.aappublications.org/content/pediatrics/133/1/105.full.pdf
15.- Shukla S, Basu S, Moritz M L. Use of Hypotonic Maintenance Intravenous Fluids and Hospital-Acquired Hyponatremia Remain Common in Children Admitted to a General Pediatric Ward. Front Pediatr [Internet]. 2016 Aug [cited March 8 2017]; 4 :90. [Above 5p.]. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4996996/pdf/fped-04-00090.pdf
16.- Friedman J N, Beck CE, De Groot J, Geary D F, Sklansky DJ, Freedman S B. Comparison of Isotonic and Hypotonic Intravenous Maintenance Fluids. A Randomized Clinical Trial. JAMA Pediatr [Internet]. 2015 [cited March 5 2017]; 169(5): [Above 7p.]. Available from:
17.- Moritz M L, Ayus J C. New aspects in the pathogenesis, prevention, and treatment of hyponatremic encephalopathy in children. Pediatric Nephrology (Berlin, Germany) [Internet]. 2010 [cited March 8 2017]; 25(7): [Above14p.]. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874061/pdf/467_2009_Article_1323.pdf
18.-Choong K, McNab S. IV fluid choices in children: have we found the solution? J Pediatr [Internet]. 2015; 91(5): [Above 3p.]. Available from: http://ac.els-cdn.com/S2255553615000920/1-s2.0-S2255553615000920-main.pdf?_tid=74330dd8-0048-11e7-91e3-00000aacb35f&acdnat=1488569864_9684248356f9d980ad43caeca26ef3df
19.-Freeman M A, Ayus J C, Moritz M L. Maintenance Intravenous Fluid Prescribing Practices Among Pediatric Residents. ActaPediatrica[Internet]. 2012 [cited March 8 2017]; 101(10): [Above10 p.]. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4042841/pdf/nihms-586463.pdf
20.-Narsaria P, Lodha R. Isn’t it Time to Stop Using 0.18% Saline in Dextrose Solutions for Intravenous Maintenance Fluid Therapy in Children? Indian Pediatrics [Internet]. 2014 Dic [cited March 7 2017]; 51(12): [Above 3p.]. Available from:http://www.indianpediatrics.net/dec2014/964.pdf
Downloads
Published
How to Cite
Issue
Section
License
Avisos de derechos de autor propuestos por Creative Commons
1. Política propuesta para revistas que ofrecen acceso abierto
Aquellos autores/as que tengan publicaciones con esta revista, aceptan los términos siguientes:
- Los autores/as conservarán sus derechos de autor y garantizarán a la revista el derecho de primera publicación de su obra, el cuál estará simultáneamente sujeto a la Licencia de reconocimiento de Creative Commons que permite a terceros compartir la obra siempre que se indique su autor y su primera publicación esta revista.
- Los autores/as podrán adoptar otros acuerdos de licencia no exclusiva de distribución de la versión de la obra publicada (p. ej.: depositarla en un archivo telemático institucional o publicarla en un volumen monográfico) siempre que se indique la publicación inicial en esta revista.
- Se permite y recomienda a los autores/as difundir su obra a través de Internet (p. ej.: en archivos telemáticos institucionales o en su página web) antes y durante el proceso de envío, lo cual puede producir intercambios interesantes y aumentar las citas de la obra publicada. (Véase El efecto del acceso abierto).
