Pediatric emergency medicine trisk 2854 2854
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TABLE 100.5
CAUSES OF HYPONATREMIA BASED UPON TOTAL BODY
SODIUM CONTENT
Low total body
sodium
Normal total body
sodium
High total body sodium
Diarrhea
Vomiting
Ostomy losses
Bleeding
Diuretic use
Mineralocorticoid
deficiency
Salt-wasting renal
disease
Cystic fibrosis
Marathon running
SIADH
Adrenal insufficiency
Hypothyroidism
Acute renal failure
Water intoxication
Pseudohyponatremia
Congestive heart failure
Nephrotic syndrome
Liver failure (cirrhosis)
Multiorgan dysfunction
Management. For children with hyponatremia associated with
hypovolemia, isotonic solutions should be provided to restore intravascular
volume. Children with symptomatic hyponatremia require urgent treatment
to avoid progressive neurologic complications. Symptoms are more likely
to develop if hyponatremia evolves rapidly, as water will move along an
osmotic gradient from the extracellular space to the intracellular space.
Given the effect of cell volume regulatory mechanisms, an important goal is
to control the rate of rise in serum sodium to prevent rapid fluid shifts into
the extracellular space and avoid the development of osmotic
demyelination. The general recommendation for a child with severe
hyponatremia is to increase the serum sodium no more rapidly than 12
mEq/L in the first 24 hours or an average of 0.5 mEq/L/hr. An exception to
this recommendation would be symptomatic hyponatremia and evolving
cerebral edema and seizures. Symptomatic hyponatremia calls for a more
aggressive initial correction of the serum sodium of approximately 2
