Elevated sweat sodium associated with pulmonary oedema in meningococcal sepsis

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Abstract
We observed a temporary positive sweat test with sodium and chloride levels greater than 60 mmol L(-1) following meningococcal septicaemia. Objective was to investigate whether this finding is reproducible and whether this disturbance in epithelial sodium transport is related to sepsis-induced pulmonary oedema. Twenty-four children with a diagnosis of meningococcal septicaemia and 10 controls with noninfectious critical illness admitted to the Royal Liverpool Children's Hospital were included. Sweat collection was by pilocarpine iontophoresis in the acute phase of the illness (days 1-5) and on follow up. Sodium and chloride concentrations were determined by flame photometry. In patients with meningococcal septicaemia, sweat sodium and chloride concentrations were significantly higher in the acute compared with the recovery phase, with a mean (SD) of 31.0 (14.6) mmol L(-1) in the acute vs. 19.6 (10.2) mmol L(-1) on recovery for sodium and 21.0 (12.1) mmol L(-1) in the acute vs. 11.8 (4.9) mmol L(-1) on recovery for chloride (P < 0.01, t-test, for sodium and chloride). Sweat sodium and chloride were significantly higher in patients with meningococcal disease compared with controls and in the acute phase in patients with septicaemia-related pulmonary oedema [mean (SD) sodium: 41.0 (15.4) mmol L(-1) and chloride: 28.8 (14.3) mmol L(-1)] compared with septic patients without [mean (SD) sodium: 24.5 (10.1) mmol L(-1) and chloride: 15.3 (7.9) mmol L(-1)] (P < 0.01 for sodium and chloride). This is the first study to provide in vivo evidence of reduced epithelial sodium transport in children with septicaemia and of its association with pulmonary oedema.