Incidence of hyponatraemia and hyponatraemic seizures in severe respiratory syncytial virus bronchiolitis
Article first published online: 2 JAN 2007
Volume 92, Issue 4, pages 430–434, April 2003
How to Cite
Hanna, S., Tibby, S., Durward, A. and Murdoch, I. (2003), Incidence of hyponatraemia and hyponatraemic seizures in severe respiratory syncytial virus bronchiolitis. Acta Paediatrica, 92: 430–434. doi: 10.1111/j.1651-2227.2003.tb00573.x
- Issue published online: 2 JAN 2007
- Article first published online: 2 JAN 2007
- Received July 19, 2002; revision received Oct. 25, 2002; accepted Nov. 7, 2002
- respiratory syncytial virus;
Aim: To document the incidence and early evolution of hyponatraemia (serum sodium <136 mmol 1−1) associated with respiratory syncytial virus (RSV) bronchiolitis in infants requiring intensive care. Methods: In a retrospective review over two winter seasons, 130 infants were admitted with confirmed RSV infection, of whom 39 were excluded because of either pre-existing risk factors for hyponatraemia: diuretic therapy (n= 14), cardiac disease (n= 10), renal disease (n= 2) or lack of admission sodium data (n= 13). Results: The incidence of admission hyponatraemia in the remaining infants (median age 6 wk) was 33% (30/91), with 11% (10/91) exhibiting a serum sodium less than 130 mmol 1−1. Hyponatraemic and normonatraemic infants were of a similar age (median 6 vs 7 wk, p= 0.82). With fluid restriction and diuretic therapy, the incidence of hyponatraemia at 48 h had decreased to 3.3%, odds ratio 0.07 (95% confidence interval 0.02–0.24, p < 0.001). Four infants (4%) suffered hyponatraemic seizures at admission (sodium 114–123 mmol 1−1); three had received hypotonic intravenous fluids at 100–150 ml kg−1 d−1 before referral to intensive care. All four were managed successfully with hypertonic (3%) saline, followed by fluid restriction, resulting in immediate termination of seizure activity and normalization of serum sodium values over 48 h.
Conclusion: Hyponatraemia is common among infants with RSV bronchiolitis presenting to intensive care. Neurological complications may occur and fluid therapy in vulnerable infants should be tailored to reduce this risk.