Hiponatremia em uma Unidade de Terapia Intensiva Pediátrica

Abstract

Objectives: To determine the prevalence and sociodemographic, clinical and prognostic outcome factors associated with hyponatremia in pediatric critical care patients who received hypotonic saline (sodium 30 mEq/L) at the rate suggested by the Holliday and Segar. Methods: A retrospective cohort study was conducted at a general Pediatric Intensive Care Unit of a University Hospital. Children and adolescents, admitted between January 2005 and December 2015, were classified according to the first serum sodium. Patients with isonatremia (135 mEq/L at 145 mEq/L), were compared with mild (130 mEq/L at 134 mEq/L), moderate (125 mEq/L at 129 mEq/L) and severe (<125 mEq/L) hyponatremia, according to sociodemographic, clinical and outcome variables. Readmissions were considered independent admissions. Results: In this study, 1055 (49.2%) of the total of 2145 admissions presented hyponatremia, of which 806 (76.4%) were mild hyponatremia. The male gender predominated in 57% (p = 0.014) and the mean age was 46.5 months (SD = 48.8). The main admission diagnoses with hyponatremia were respiratory failure and postoperative cardiac surgery. Hyponatremia on admission was more associated with clinical diagnoses (n = 290, 61.3%) and hyponatremia acquired during hospitalization (n = 257, 53.3%) with surgical ones (p <0.000). Hyponatremia had a longer duration of mechanical ventilation and death was observed in 8.5% (n = 90, p = 0.000). Significant independent risk factor for hyponatremia were longer length of stay (Odds Ratio (OR) 1.18 [95% CI, 1.132 to 1.230], p = 0.000) and PRISM score (OR 1.024 [95% CI, 1.002 to 1.046], p = 0.033). Conclusions: The prevalence of hyponatremia in this population was high. Hypotonic fluids, length of stay and PRISM could be associated with the development of hyponatremia.