Predictive Factors of Hyponatremia in Under-Five Severely Malnourished Children with Pneumonia Admitted to a Large Urban Hospital in Dhaka, Bangladesh: A Nested Case-Control Design

DOI: 10.4236/fns.2013.44051   PDF   HTML     3,835 Downloads   5,921 Views   Citations

Abstract

Background: Hyponatremia is the most common electrolyte imbalance encountered in the management of diarrheal children. Common ramifications include cerebral edema and fatal outcomes. However, pediatric data remain lacking, particularly in developmental contexts where resources are limited and associated conditions like malnutrition and pneumonia are common. Aim: This study aimed to evaluate predicting factors associated with hyponatremia in children under five years of age with severe acute malnutrition (SAM) in Bangladesh. Methods: Using a nested case-control design, we compared clinical and laboratory characteristics of children with (n = 61) and without hyponatremia (n = 183) taken from a parent population of all children under five with SAM and clinical or radiological pneumonia admitted to Dhaka Hospital of icddr,b between April 2011 and June 2012 (n = 407). Results: Logistic regression analysis adjusting for potential confounders such as lack of breast feeding, duration of vomiting (days), and severe wasting revealed that older age (OR 1.05, 95%CI 1.02 - 1.07, p = 0.001) (5% increase in the relative odds of hyponatremia for each additional month of age), presence of diarrhea (OR 2.43, 95%CI 1.0 - 6.0, p = 0.05), and difficulty breathing (OR 1.52, 95%CI 1.0 - 2.05, p = 0.05) were significantly associated with hyponatremia. Conclusion: Our data suggest that older age, presence of diarrhea, and difficulty breathing in under-five children with SAM is independent predictors of hyponatremia. These findings underscore the importance of detecting simple clinical predictors early in order to facilitate appropriate management and to prevent potential ramifications of hyponatremia in SAM children, especially in resource-poor settings.

Share and Cite:

C. Zogg, T. Ahmed, A. Faruque, S. Das, G. Imran and M. Chisti, "Predictive Factors of Hyponatremia in Under-Five Severely Malnourished Children with Pneumonia Admitted to a Large Urban Hospital in Dhaka, Bangladesh: A Nested Case-Control Design," Food and Nutrition Sciences, Vol. 4 No. 4, 2013, pp. 398-404. doi: 10.4236/fns.2013.44051.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] M. L. Moritz and J. C. Ayus, “New Aspects in the Patho genesis, Prevention, and Treatment of Hyponatremic En cephalopathy in Children,” Pediatric Nephrology, Vol. 25, No. 7, 2010, pp. 1225-1238. doi:10.1007/s00467-009-1323-6
[2] A. Sakellaropoulou, M. Hatzistilinou, M. Eboriadou and F. Athanasiadou-Piperopoulou, “Hyponatremia in Cases of Children with Pneumonia,” Achieves of Medical Science, Vol. 6, No. 4, 2010, pp. 578-583. doi:10.5114/aoms.2010.14471
[3] R. J. Anderson, H. M. Chung, R. Kluge and R. W. Schrier, “Hyponatremia: A Prospective Analysis of Its Epidemiology and the Pathogenic Role of Vasopressin,” Annals of Internal Medicine, Vol. 102, No. 2, 1985, pp. 164-168.
[4] H. Hasegawa, S. Okubo, Y. Ikezumi, K. Uchiyama, T. Hirokawa, H. Hirano and M. Uchiyama, “Hyponatremia Due to an Excess of Arginine Vasopressin Is Common in Children with Febrile Disease,” Pediatric Nephrology, Vol. 24, No. 3, 2009, pp. 507-511. doi:10.1007/s00467-008-1053-1
[5] M. Don, G. Valerio, M. Korppi and Canciani M, “Hyponatremia in Pediatric Community-Acquired Pneumonia,” Pediatric Nephrology, Vol. 23, No. 12, 2008, pp. 2247-2253. doi:10.1007/s00467-008-0910-2
[6] E. J. Hoorn, D. Geary, M. Robb, M. L. Halperin and D. Bohn, “Acute Hyponatremia Related to Intravenous Fluid Administration in Hospitalized Children: An Observational Study,” Pediatrics, Vol. 113, No. 5, 2004, pp. 1279-1284. doi:10.1542/peds.113.5.1279
[7] K. Armon, A. Riordan, S. Playfor, G. Millman and A. Khader, “Hyponatraemia and Hypokalemia during Intra venous Fluid Administration,” Archives of Disease in Childhood, Vol. 93, 2008, pp. 285-287. doi:10.1136/adc.2006.093823
[8] A. Wattad, M. L. Chiang and L. L. Hill, “Hyponatremia in Hospitalized Children,” Clinical Pediatrics, Vol. 31, No. 3, 1992, pp. 153-157. doi:10.1177/000992289203100305
[9] M. L. Moritz and J. C. Ayus, “Disorders of Water Metabolism in Children: Hyponatremia and Hypernatremia,” Pediatrics in Review, Vol. 23, No. 11, 2002, pp. 371-380.
[10] F. Laczi, “Etiology, Diagnostics and Therapy of Hypona tremias,” Orvosi Hetilap, Vol. 149, No. 29, 2008, pp. 1347-1354. doi:10.1556/OH.2008.28409
[11] M. D. Zilberberg, A. Exuzides, J. Spalding, A. Foreman, A. G. Jones, C. Colby and A. F. Shorr, “Epidemiology, Clinical and Economic Outcomes of Admission Hyponatremia among Hospitalized Patients,” Current Medical Research & Opinion, Vol. 24, No. 6, 2008, pp. 1601-608. doi:10.1185/03007990802081675
[12] F. Cetinkaya, E. Sennaroglu and S. Comu, “Etiologies of Seizures in Young Children Admitted to an Inner City Hospital in a Developing Country,” Pediatric Emergency Care, Vol. 24, No. 11, 2008, pp. 761-763. doi:10.1097/PEC.0b013e31818c2652
[13] H. Caksen, D. Odabas, S. Sar, V. Celebi, S. Arslan, M. Kuru and M. Abduhandan, “Hyponatremic Dehydration: An Analysis of 78 Cases,” International Urology & Nephrology, Vol. 33, No. 3, 2001, pp. 445-448. doi:10.1023/A:1019563222488
[14] H. C. Farrar, V. T. Chande, D. F. Fitzpatrick and S. J. Shema, “Hyponatremia as the Cause of Seizures in Infants: A Retrospective Analysis of Incidence, Severity, and Clinical Predictors,” Annals of Emergency Medicine, Vol. 26, No. 1, 1995, pp. 42-48. doi:10.1016/S0196-0644(95)70236-9
[15] A. R. Samadi, M. A. Wahed, M. R. Islam and S. M. Ah med, “Consequences of Hyponatraemia and Hyperna traemia in Children with Acute Diarrhoea in Bangladesh,” British Medical Journal, Vol. 286, No. 6366, 1983, pp. 671-673. doi:10.1136/bmj.286.6366.671
[16] Y. Memon, R. Majeed, M. H. Ghani and S. Shaikh, “Se rum Electrolytes Changes in Malnourished Children with Diarrhoea,” Pakistan Journal of Medical Sciences, Vol. 23, No. 5, 2007, pp. 760-764.
[17] S. K. Mishra, S. P. Bastola and B. Jha, “Biochemical Nutritional Indicators in Children with Protein Energy Malnutrition Attending Kanti Children Hospital, Kath mandu, Nepal,” Kathmandu University Medical Journal, Vol. 7, No. 2, 2009, pp.129-134.
[18] World Health Organization, “MDG 4: Reduce Child Mortality,” 2012. http://www.who.int/topics/millennium_development_goals/child_mortality/en/index.html
[19] J. Bryce, C. Boschi-Pinto, K. Shibuya, R. E. Black and WHO Child Health Epidemiology Reference Group, “WHO Estimates of the Causes of Death in Children,” The Lancet, Vol. 365, No. 9465, 2005, pp. 1147-1152. doi:10.1016/S0140-6736(05)71877-8
[20] L. E. Caulfield, M. de Onis and R. E. Black, “Undernutrition as an Underlying Cause of Child Deaths Associated with Diarrhea, Pneumonia, Malaria, and Measles,” The American Journal of Clinical Nutrition, Vol. 80, No. 1, 2002, pp. 193-198.
[21] A. I. Rice, I. Sacco, A. Hyder and R. E. Black, “Malnutri tion as an Underlying Cause of Childhood Deaths Associated with Infectious Diseases in Developing Countries,” Bulletin of the World Health Organization, Vol. 78, No. 10, 2000, pp. 1207-1221.
[22] D. I. Pelletier and E. A. Frongillo, “Changes in Child Survival are Strongly Associated with Changes in Malnutrition in Developing Countries,” The Journal of Nutrition, Vol. 133, No. 1, 2003, pp. 107-119.
[23] S. Collins, N. Dent, P. Binns, P. Bahwere, K. Sadler and A. Hallam, “Management of Severe Acute Malnutrition in Children,” The Lancet, Vol. 368, No. 9551, 2006, pp. 1992-2000. doi:10.1016/S0140-6736(06)69443-9
[24] R. Hajjeh and C. G. Whitney, “Call to Action on World Pneumonia Day,” Emerging Infectious Diseases, Vol. 18, No. 11, 2012, pp. 1896-1897.
[25] L. Liu, H. L. Johnson, S. Cousens, J. Perin, S. Scott, J. E. Lawn, I. Rudan, H. Campbell, R. Cibulskis, M. Li, C. Mathers, R. E. Black and Child Health Epidemiology Reference Group of WHO and UNICEF, “Global, Regional, and National Causes of Child Mortality: An Up dated Systematic Analysis for 2010 with Time Trends Since 2000,” The Lancet, Vol. 379, No. 9832, 2012, pp. 2151-2161. doi:10.1016/S0140-6736(12)60560-1
[26] J. G. Verbalis, S. R. Goldsmith, A. Greenberg, R. W. Schrier and R. H. Sterns, “Hyponatremia Treatment Guide lines 2007: Expert Panel Recommendations,” The American Journal of Medicine, Vol. 120, No. 11, 2007, pp. S1-S21. doi:10.1016/j.amjmed.2007.09.001
[27] B. J. Feldman, S. M. Rosenthal, G. A. Vargas, R. G. Fen wick, E. A. Huang, M. Matsuda-Abedini, R. H. Lustig, R. S. Mathias, A. A. Portale, W. L. Miller and S. E. Gitel man, “Nephrogenic Syndrome of Inappropriate Antidiuresis,” The New England Journal of Medicine, Vol. 352, 2005, pp. 1884-1890. doi:10.1056/NEJMoa042743
[28] World Health Organization and United Nations Children’s Fund, “WHO Child Growth Standards and the Identification of Severe Acute Malnutrition in Infants and Children,” WHO Press, Geneva, 2009.
[29] M. J. Chisti, T. Ahmed, P. K. Bardhan and M. A. Salam, “Evaluation of Simple Laboratory Investigations to Predict Fatal Outcomes in Infants with Severe Malnutrition Presenting in an Urban Diarrhoea Treatment Centre in Bangladesh,” Topical Medicine & International Health, Vol. 15, No. 11, 2010, pp. 1322-1325. doi:10.1111/j.1365-3156.2010.02619.x
[30] C. G. Murphy, A. C. van de Pol, M. B. Harper and R. G. Bachur, “Clinical Predictors of Occult Pneumonia in the Febrile Child,” Academic Emergency Medicine, Vol. 14, No. 3, 2007, pp. 243-249. doi:10.1111/j.1553-2712.2007.tb01781.x
[31] C. A. Piantadosi and D. A. Schwartz, “The Acute Respiratory Distress Syndrome,” Annals of Internal Medicine, Vol. 141, No. 4, 2004, pp. 460-470.
[32] F. S. Calandrino Jr., D. J. Anderson, M. A. Mintun and D. P. Schuster, “Pulmonary Vascular Permeability during the Adult Respiratory Distress Syndrome: A Positron Emission Tomographic Study,” American Journal of Respiratory & Critical Care Medicine, Vol. 138, No. 2, 1988, pp. 421-428.
[33] L. B. Ware and M. A. Matthay, “Alveolar Fluid Clearance Is Impaired in the Majority of Patients with Acute Lung Injury and the Acute Respiratory Distress Syndrome,” American Journal of Respiratory & Critical Care Medicine, Vol. 163. No. 6, 2001, pp. 1376-1383.
[34] W. R. Baumann, R. C. Jung, M. Koss, C. T. Boylen, L. Navarro and O. P. Sharma, “Incidence and Mortality of Adult Respiratory Distress Syndrome: A Prospective Analysis from a Large Metropolitan Hospital,” Critical Care Medicine, Vol. 14, No. 1, 1986, pp. 1-4. doi:10.1097/00003246-198601000-00001
[35] M. J. Chisti, T. Ahmed, H. Ashraf, A. S. G. Faruque, P. K. Bardhan, S. K. Dey, S. Huq, S. K. Das and M. A. Salam, “Clinical Predictors and Outcome of Metabolic Acidosis in Under-Five Children Admitted to an Urban Hospital in Bangladesh with Diarrhea and Pneumonia,” PLoS One, Vol. 7, No. 6, 2012, Article ID: e39164. doi:10.1371/journal.pone.0039164
[36] T. Ahmed, M. Ali, M. M. Ullah, I. A. Choudhury, M. E. Haque, M. A. Salam, G. H. Rabbani, R. M. Suskind and G. J. Fuchs, “Mortality in Severely Malnourished Children with Diarrhoea and Use of a Standardized Management Protocol,” The Lancet, Vol. 353, No. 9168, 1999, pp. 1919-1922. doi:10.1016/S0140-6736(98)07499-6

  
comments powered by Disqus

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.