Pediatric emergency medicine trisk 2852 2852
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sequelae, and overly aggressive treatment of each can cause significant
CNS complications. Treatment corrects the sodium abnormalities using
estimated volume status and total body sodium content. Severe cases need
to be treated at an appropriate rate in order to prevent CNS complications.
CLINICAL PEARLS AND PITFALLS
Hyponatremia may occur secondary to increased ADH activity or
in patients with hypovolemia managed with excess free water.
Hypernatremia is usually due to excessive water loss relative to
sodium and is associated with gastrointestinal illness or systemic
infection.
Hypernatremia may occur in infants due to inadequate
breastfeeding or increased sodium load from improperly mixed
formula.
Clinical manifestations of hypo- or hypernatremia depend on the
severity and rate of development.
Overly rapid correction of hypo- or hypernatremia may lead to
severe CNS sequelae.
Hyponatremia
When approaching a patient with hyponatremia, it is necessary to estimate
the patient’s total body sodium and water based on history and physical
examination. There are numerous causes of hyponatremia ( Table 100.5 )
associated with normal or increased total body sodium, including states of
impaired water excretion such as renal failure and the syndrome of
inappropriate antidiuretic hormone (SIADH) secretion. Release of ADH is
associated with a number of clinical conditions, including hypovolemia,
fever, gastroenteritis, CNS trauma, CNS infections and tumors, pulmonary
infections, hypothyroidism, and cortisol deficiency. Certain medications,
including some chemotherapeutic agents and antiepileptic agents, can be
associated with inappropriate ADH release. It is critical to assess for
underlying causes associated with increased total body sodium and water, as
in the edema-forming states. In these clinical circumstances, providing
supplemental sodium would aggravate the state of volume excess.
