Acute Hyponatremia Related to Intravenous Fluid Administration in Hospitalized Children: An Observational Study

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Abstract
Objective. To develop hyponatremia (plasma sodium concentration [PNa] Methods. All children who presented to the emergency department in a 3-month period and had at least 1 PNa measured (n = 1586) were evaluated. Those who were admitted were followed for the next 48 hours to identify patients with hospital-acquired hyponatremia. An age- and gender-matched case-control (1:3) analysis was performed with patients who did not become hyponatremic. Results. Hyponatremia (PNa Na measurements. Although 96 patients were hyponatremic on presentation, our study group consisted of 40 patients who developed hyponatremia in hospital. The case-control study showed that the patients in the hospital-acquired hyponatremia group received significantly more EFW and had a higher positive water balance. With respect to outcomes, 2 patients had major neurologic sequelae and 1 died. Conclusion. The most important factor for hospital-acquired hyponatremia is the administration of hypotonic fluid. We suggest that hypotonic fluid not be given to children when they have a PNa <138 mmol/L.