Abstract
Lower respiratory tract infection (LRTI) is an important cause of hospitalization
in pediatric population. Hyponatremia is frequently present in children hospitalized
with pneumonia and bronchiolitis and is associated with poorer outcomes. We conducted
a study to identify the risk factors for hyponatremia in hospitalized children with
LRTI and to evaluate the relationship between serum sodium levels and severity of
respiratory distress. A total of 147 patients between 2 months and 12 years of age,
admitted with the diagnosis of LRTI at the Mahatma Gandhi Mission Hospital and Medical
College, a tertiary hospital in Navi Mumbai, Maharashtra, India, between December
2017 and November 2019, were studied prospectively. Patients with any other comorbidities
were excluded. The severity of respiratory distress at presentation was graded using
the Clinical Respiratory score (CRS). Serum electrolytes were sent within 1 hour of
hospital admission. Median age of enrolled patients was 14 months. Overall, 23 (16%)
children had mild respiratory distress, 97 (66%) had moderate respiratory distress,
and 26 (18%) had severe distress. The incidence of hyponatremia in children admitted
with LRTI was 66% and majority of them (70%) had mild hyponatremia. The incidence,
as well as severity of hyponatremia differed significantly with etiology (p < 0.05). An inverse correlation was found between serum sodium levels and CRS at
presentation (r = − 0.26, p = 0.001). In multivariate analyses, parenchymal disease was an independent risk factor
for development of hyponatremia (adjusted odds ratio [aOR] = 5.64 (2.52–12.59), p < 0.001). Incidence and severity of hyponatremia in children with LRTI increased
with severity of respiratory distress and presence of parenchymal disease.
Keywords
hyponatremia - LRTI - clinical respiratory score - children
