Sodium Disturbances in Children Admitted to a Kenyan Hospital: Magnitude, Outcome and Associated Factors

Abstract

Background: Perturbations of blood sodium are the most frequently encountered electrolyte disorder in sick children, and may influence fluid therapy. We examined the frequency of blood sodium perturbations, and factors and outcomes associated with hyponatremia in children admitted to a rural Kenyan hospital and investigated the risk factors associated with deaths in hyponatremic children.

Methods: Plasma sodium levels and other laboratory parameters were measured in children admitted to a rural Kenyan hospital. Clinical measurements were collected using standard forms and entered into a computer database. The proportion of children admitted with hyponatremia was determined. Logistic regression models were used to investigate factors associated with hyponatremia, and death in those with hyponatremia.

Results: Abnormal plasma sodium occurred in 46.6% (95% confidence interval (95%CI) 43.5-49.6%) of 1026 pediatric admissions. Hyponatremia occurred in 44.4% (95%CI 41.4-47.5%) and hypernatremia in 2.1% (95%CI 1.3-3.0%). Malaria (40.8%) was the most common underlying primary diagnosis in hyponatremic children. Malaria, hyperglycemia, wasting, high creatinine levels and preserved consciousness were associated with hyponatremia. Pallor and seizures were associated with increased mortality in hyponatremic children.

Conclusions: Sodium disturbances are common in pediatric admissions to a County hospital in rural Kenya. Seizures and pallor were predictors of mortality in hyponatremic children.

Fig 1. Most common underlying conditions in children with hyponatremia.

This figure shows the most common underlying conditions in hyponatremic children. Red shows the percentage of children with the condition while blue represents the percentage that died from that condition.

Fig 2. Most common underlying conditions in children with hypernatremia.

This figure shows the most common underlying conditions in hypernatremic children. Red shows the percentage of children with the condition while blue represents the percentage that died from that condition. A completely blue bar means that all children with that condition died.