Paeds Vivas · nephrology-urology-fluids-and-electrolytes
Hyponatraemia and hypernatraemia — viva
Branching structured oral on a seizing child with hyponatraemia on hypotonic fluid: 3% NaCl boluses, anticonvulsant failure, demyelination risk, correction limits, SIAD and isotonic fluid caution, prevention, and the hypernatraemia correction evidence.
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Prompt
A 4-year-old girl recovering from pneumonia on the ward has a generalised seizure. Her serum sodium is 117 mmol/L. She has been on 0.45 percent saline with dextrose for two days. You are the paediatric registrar. Take me through your immediate management and your reasoning.
Opening (must-hit)
"A seizure with a sodium of 117 mmol/L in a child on hypotonic fluid suggests hyponatraemic encephalopathy. I would give a 2 mL/kg bolus of 3% NaCl and repeat it 1 to 2 times if symptoms persist, as Ayus and Moritz advise." [2]
References6ShowHide
- [2]Ayus JC, Moritz ML Misconceptions and Barriers to the Use of Hypertonic Saline to Treat Hyponatremic Encephalopathy. Frontiers in medicine, 2019.PMID 30931308
- [3]Sarnaik AP, Meert K, Hackbarth R, et al. Management of hyponatremic seizures in children with hypertonic saline: a safe and effective strategy. Critical care medicine, 1991.PMID 2055051
- [5]Feld LG, Neuspiel DR, Foster BA, et al. Clinical Practice Guideline: Maintenance Intravenous Fluids in Children. Pediatrics, 2018.PMID 30478247
- [6]Amer BE, Abdelwahab OA, Abdelaziz A, et al. Efficacy and safety of isotonic versus hypotonic intravenous maintenance fluids in hospitalized children: an updated systematic review and meta-analysis of randomized controlled trials. Pediatric nephrology (Berlin, Germany), 2024.PMID 37365423
- [9]Didsbury M, See EJ, Cheng DR, et al. Correcting Hypernatremia in Children. Clinical journal of the American Society of Nephrology : CJASN, 2023.PMID 36888887
- [11]Moritz ML Syndrome of Inappropriate Antidiuresis. Pediatric clinics of North America, 2019.PMID 30454744