Electrolyte disorders related emergencies in children

Abstract

This article provides a comprehensive overview of electrolyte and water homeostasis in pediatric patients, focusing on some of the common serum electrolyte abnormalities encountered in clinical practice. Understanding pathophysiology, taking a detailed history, performing comprehensive physical examinations, and ordering basic laboratory investigations are essential for the timely proper management of these conditions. We will discuss the pathophysiology, clinical manifestations, diagnostic approaches, and treatment strategies for each electrolyte disorder. This article aims to enhance the clinical approach to pediatric patients with electrolyte imbalance-related emergencies, ultimately improving patient outcomes.Trial registration This manuscript does not include a clinical trial; instead, it provides an updated review of literature.

Keywords: Electrolyte imbalances; Hypercalcemia; Hyperkalemia; Hypernatremia; Hypocalcemia; Hypokalemia; Hyponatremia; Pediatrics.

Fig. 1

Body fluid compartments. Illustration of the fluid compartments within the body. ECF-extracellular fluid, ICF-intracellular fluid, ISF-interstitial fluid, IVF-intravascular fluid, TCF-transcellular fluid

Fig. 2

Algorithm for differential diagnosis of hyponatremia, modified according to Zieg, J [13]. Low plasma osmolality is diagnostic for hypotonic hyponatremia, therefore pseudohyponatremia and translational hyponatremia must be excluded first. The next step is to assess the current volume status. The diagnostic workup should include basic measurement of plasma and urinary sodium and creatinine to calculate FENa. Both volume status and value of FENa are used to determine the cause of hyponatremia. SIADH- syndrome of inappropriate antidiuretic hormone, AKI- acute kidney injury, CKD- chronic kidney disease, FENa- fractional excretion of sodium (urinary sodium × serum creatinine)/(urinary creatinine × serum sodium) × 100

Fig. 3

Algorithm for differential diagnosis of hypernatremia, modified according to Bockenhauer et al. and Zieg, J [18, 19]. After excluding pseudohypernatremia, early management is tailored to the volume status and weight of the patient. While free water loss and insufficient water intake are associated with weight loss and low urine sodium, children with salt intoxication gain weight and their urine sodium is high. Measurement of plasma and urine osmolality is important in determining the cause of hypernatremia

Fig. 4

Algorithm for differential diagnosis of hyperkalemia, modified according to Yang et al. [43]. After excluding pseudohyperkalemia, urinary potassium wasting using TTKG and urine output volume are assessed to divide hyperkalemic children into three groups. Plasma aldosterone level is used to further discriminate individuals with reduced potassium wasting and adequate urine output. K- potassium, AKI- acute kidney injury, CKD- chronic kidney disease, PHA- pseudohypoaldosteronism, RTA- renal tubular acidosis, COX- cyclooxygenase, RAAS- renin–angiotensin–aldosterone-system, RBC- red blood cells, IV-intravenous, Osm-osmolality, TTGK- trans-tubular potassium gradient