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Dysnatremia and subsequent sodium level changes following various intravenous treatments in infants with acute gastroenteritis

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Abstract

Acute gastroenteritis is one of the main causes of electrolyte imbalance in infants. We aimed to determine the frequency of and factors associated with dysnatremia at presentation and establish the ideal intravenous treatment scheme. The records of hospitalized infants aged 1–12 months with community-acquired acute gastroenteritis between January 2017 and March 2021 were retrospectively reviewed. Factors associated with dysnatremia at presentation were analyzed by multivariable logistic regression analysis. Subsequent sodium levels 4–24 h after intravenous fluid treatments, which were categorized into 2 groups, were determined in the subgroup of infants with normal sodium levels at presentation. A total of 347 infants with a median age of 8.0 (5.0–10.0) months were included. The frequency of dysnatremia at presentation was 14% (hyponatremia 12% and hypernatremia 2.0%). Severe dehydration was associated with dysnatremia at presentation (p = 0.048). Among 68 infants with normal sodium levels at presentation, the median sodium change was highest in the 5% dextrose in saline group, with changes of + 3 (0.5–5) and + 1 (− 2 to 2) mmol/L in infants who received 5% dextrose in saline and 5% dextrose in 1/3–1/2 saline, respectively (p = 0.001). Four out of 47 infants (8.5%) developed hyponatremia while receiving 5% dextrose in 1/3–1/2 saline. None of those who received 5% dextrose in saline developed subsequent dysnatremia.

  Conclusion: The frequency of dysnatremia at presentation among infants with acute gastroenteritis was 14%. Severe dehydration was associated with dysnatremia at presentation, so electrolyte levels need to be assessed in these patients. The use of isotonic solution did not promote acquired dysnatremia. This study supports once more that current guidelines recommending isotonic solution for children, and, especially, infant rehydration, are important also for infants in Thailand.

What is Known:

• There were a wide variation in the incidence of dysnatremia at presentation in children with acute gastroenteritis in previous pediatric series.

• The AAP guidelines recommend using isotonic solution in children with acute illness from 28 days to 18 years of age to prevent acquired hyponatremia.

What is New:

• The incidence of dysnatremia at presentation in infants with acute gastroenteritis was 14% (hyponatremia 12% and hypernatremia 2.0%).

• The use of isotonic solution did not promote acquired dysnatremia in infants with acute gastroenteritis.

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Abbreviations

AAP:

American Academy of Pediatrics

ADH:

Antidiuretic hormone

D5-NS:

5% Dextrose in saline

D5-1/2NS:

5% Dextrose in 1/2 saline

D5-1/3NS:

5% Dextrose in 1/3 saline

D5-1/4NS:

5% Dextrose in 1/4 saline

D5-1/5NS:

5% Dextrose in 1/5 saline

IV:

Intravenous

IQR:

Interquartile ranges

ORs:

Odds ratios

ORS:

Oral rehydration solutions

SD:

Standard deviation

SPSS:

PASW Statistics

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Authors and Affiliations

  1. Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Wattanaporn Sakkongviseth & Kanokwan Sommai

  2. Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Achra Sumboonnanonda, Anirut Pattaragarn, Suroj Supavekin, Nuntawan Piyaphanee, Kraisoon Lomjansook, Yarnarin Thunsiribuddhichai & Thanaporn Chaiyapak

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  1. Wattanaporn Sakkongviseth
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  2. Kanokwan Sommai
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  3. Achra Sumboonnanonda
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Contributions

T.C. designed the study and contributed to the methodology. W.S. collected the data. K.S. performed the analysis. W.S. and T.C. wrote the manuscript. W.S., K.S., A.S., A.P., S.S., N.P., K.L., Y.T., and T.C. contributed to the interpretation of data, participated in critical revision of the manuscript for important intellectual content, and read and approved the final manuscript.

Corresponding author

Correspondence to Thanaporn Chaiyapak.

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This study was performed in line with the principles of the Declaration of Helsinki. This protocol was approved by the Siriraj Hospital Ethics Board (Si 442/2021).

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The authors declare no competing interests.

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Communicated by Gregorio Milani

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Sakkongviseth, W., Sommai, K., Sumboonnanonda, A. et al. Dysnatremia and subsequent sodium level changes following various intravenous treatments in infants with acute gastroenteritis. Eur J Pediatr 182, 4741–4748 (2023). https://doi.org/10.1007/s00431-023-05151-5

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