Incidence and Risk Factors for Hyponatremia in Hospitalized Children with Lower Respiratory Tract Infections

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

Publication History

Received: 08 December 2021

Accepted: 15 April 2022

Article published online:
27 June 2022

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