Electrolyte disorders in acutely ill children: Pediatricians, mothers or climate change, who is to blame?
More details
Hide details
University of Milan, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
Publication date: 2022-05-27
Public Health Toxicol 2022;2(Supplement 1):A37
Circulating sodium abnormalities are associated with an increased risk of morbidity and mortality in patients requiring emergency care. In children with acute gastroenteritis, a major cause of visits in the pediatric emergency department, dysnatremias are observed in one every two cases. Despite common both in infants and adults, the underlying causes of sodium abnormalities in these two age groups are different in most cases. Until the 1980s, hypernatremia was very frequent and hyponatremia uncommon in pediatric subjects affected by acute gastroenteritis. In the following years, hypernatremia almost disappeared, and the prevalence of hyponatremia increased. It is assumed that the resurgence of breastfeeding, formulas having less salt, and early and fast reintroduction of mostly hypotonic fluids, account for this change. New data suggest that climate change could also be a contributing factor. On the other hand, recently published observations point out that hyponatremia might be significantly more frequent in infants affected by bronchiolitis and pyelonephritis than in acute gastroenteritis. The different pathogenetic mechanisms underlying dysnatremia in these conditions have relevant consequences for the nutrition and rehydration management. This talk will deal with these issues and briefly address the approach to acutely ill infants presenting electrolyte imbalances.
Mazzoni MB, Milani GP, Bernardi S, et al. Hyponatremia in infants with community-acquired infections on hospital admission. PLoS One. 2019;14(7):e0219299. doi:10.1371/journal.pone.0219299
Milani GP, Lo Leggio A, Castellazzi ML, Agostoni C, Bianchetti MG, Carugno M. Outdoor temperature and circulating sodium in children with acute gastroenteritis. Pediatr Res. 2022. doi:10.1038/s41390-022-01947-7
Sailer CO, Winzeler B, Nigro N, Bernasconi L, Mueller B, Christ-Crain M. Influence of Outdoor Temperature and Relative Humidity on Incidence and Etiology of Hyponatremia. J Clin Endocrinol Metab. 2019;104(4):1304-1312. doi:10.1210/jc.2018-01507
Memoli E, Lava SAG, Bianchetti MG, Vianello F, Agostoni C, Milani GP. Prevalence, diagnosis, and management of secondary pseudohypoaldosteronism. Pediatr Nephrol. 2020;35(4):713-714. doi:10.1007/s00467-019-04419-z
Milani GP, Grava A, Bianchetti MG, et al. Electrolyte and Acid-Base Abnormalities in Infants with Community-Acquired Acute Pyelonephritis: Prospective Cross-Sectional Study. Nephron. 2017;137(2):99-104. doi:10.1159/000478054
Lavagno C, Milani GP, Uestuener P, et al. Hyponatremia in children with acute respiratory infections: A reappraisal. Pediatr Pulmonol. 2017;52(7):962-967. doi:10.1002/ppul.23671
Bertini A, Milani GP, Simonetti GD, et al. Na(+), K(+), Cl(-), acid-base or H2O homeostasis in children with urinary tract infections: a narrative review. Pediatr Nephrol. 2016;31(9):1403-1409. doi:10.1007/s00467-015-3273-5
Peruzzo M, Milani GP, Garzoni L, et al. Body fluids and salt metabolism - Part II. Ital J Pediatr. 2010;36(1):78. doi:10.1186/1824-7288-36-78
Chin X, Teo SW, Lim ST, Ng YH, Han HC, Yap F. Desmopressin therapy in children and adults: pharmacological considerations and clinical implications. Eur J Clin Pharmacol. 2022. doi:10.1007/s00228-022-03297-z