ABSTRACT
Background: Traumatic brain injury (TBI) is a one of the commonest injuries treated at the Neurosurgery Department. The incidence rate is approximately 3% in the general population and the mortality rate is about 30% of all injury deaths. Hyponatremia leads to high morbidity and/or mortality in TBI patients. Our study discusses the epidemiology of TBI associated with hyponatremia. Methods: Retrospective analysis of 80 patients with TBI between February 2017 and November 2018 was performed. The relationship between the incidence of hyponatremia in TBI patients and age, sex, GCS, type, severity of injury and whether the patient was submitted to surgery or not. Results: Out of 80 TBI patients recruited for the study, 25 of them suffered from hyponatremia. Hyponatremia following TBI wasn't related to age, sex but it was related to the type of injury, the Glasgow Coma Scale (GCS) score ⤠8, surgical history. TBI with hyponatremia usually had longer stay in the hospital and bad outcome. Conclusions: Sever TBI patients (GCS score ⤠8), intracranial hemorrhage and/or skull base fracture are susceptible to developing hyponatremia and require additional treatment aiming to normalization of serum sodium levels to prevent deterioration of their condition. Abbreviations: ANP, Atrial natriuretic peptide; CSWS, Cerebral salt wasting syndrome; SIADH, Syndrome of inappropriate secretion of antidiuretic hormone; TBI, Traumatic brain injury
Subject(s)
Antidiuretic Hormone Receptor Antagonists , Brain Injuries, Traumatic , Hormones , Hyponatremia , Inappropriate ADH Syndrome , Wasting SyndromeABSTRACT
INTRODUCTION : La deshydratation aigue represente une urgence pediatrique courante; generalement secondaire a la diarrhee aigue. L'objectif de cette etude etait d'apprecier; au cours de la deshydratation aigue; la prevalence des dysnatremies; leur impact sur la morbi-mortalite et les implications therapeutiques dans la prise en charge.MATERIEL ET METHODES : Il s'agissait d'une etude retrospective menee sur deux ans (2009 a 2010); au Centre National Hospitalier d'Enfants Albert Royer; incluant tous les enfants de 2 mois a 5 ans; souffrant de deshydratation aigue et ayant eu un ionogramme sanguin. Sur 310 cas de deshydratation recenses; 205 dossiers repondaient aux criteres d'inclusion et ont constitue notre population d'etude. Nous avons recueilli les donnees epidemiologiques; cliniques; biologiques; therapeutiques et evolutives. Nous avons retenu la classification de la deshydratation en legere; moderee et severe qui figurait dans le dossier. L'hyponatremie etait definie par une natremie strictement inferieure a 135 mmol/l; l'hypernatremie par une natremie superieure a 150 mmol/l. L'analyse a ete faite sur Epi info 3.5. Un p 0.05 etait considere comme significatif. RESULTATS : L'incidence de la deshydratation etait de 3;78%. L'age moyen etait de 12.2 mois (2 a 48 mois) et le sex ratio de 1;52 en faveur des garcons. Il y avait deux pics d'hospitalisation; en janvier-fevrier et en septembre. Un trouble digestif (diarrhee ou vomissements) etait present chez 202 enfants (98;5%) et la denutrition chez 35 enfants (17;1%). La gastroenterite aigue (159 cas) representait 77;5% des causes. La deshydratation etait jugee legere dans 20 cas (9;7 %); moderee dans 91 cas (44;4%) et severe [JK1] dans 94 cas (45;8%). [JK2] L'hyponatremie etait presente chez 105 enfants (51;2%) et elle etait severe; inferieure a 125 mmol/l; chez 28 (13;7%). L'hypernatremie etait notee chez 15 enfants (7;3%). Quatre-vingt pour cent des hypernatremies et 51;5% des hyponatremies etaient associees a une deshydratation severe (P
Subject(s)
Child , Dehydration , Gastroenteritis , Hypernatremia , HyponatremiaABSTRACT
La natremie reflete l'etat d'hydratation du patient. L'hyponatremie represente l'anomalie hydro-electrolytique la plus frequente en reanimation. Ce trouble entraine souvent une diminution de la tonicite extracellulaire avec un passage d'eau en intracellulaire. La gravite de l'hyponatremie resulte de l'installation d'un oedeme cerebral avec hypertension intracranienne. Les vraies hyponatremies sont a distinguees des pseudo hyponatremies secondaires a une hyperglycemie; une hyper protidemie ou a une hypertriglyceridemie. La correction de la natremie doit etre progressive a raison de 1;5 a 2 mmol.L-1.h-1 pour eviter une myelinolyse centropontique. L'objectif de ce travail est de faire une mise au point sur les principales etiologies de l'hyponatremie en milieu de reanimation et leur prise en charge
Subject(s)
Disease Management , Hyponatremia/etiology , Myelinolysis, Central Pontine , ResuscitationABSTRACT
Background: Electrolyte disturbances and renal impairment have been reported in patients with severe malaria (SM). However, the contributing mechanisms are not well identified.Objectives: The study aims to identify disturbances in electrolytes and renal functions in children with SM and their possible pathophysiology. Methods: The study included fifty six children with SM identified according to WHO criteria of SM. Investigations included parasitemia; glucose; urea; creatinine; sodium; and potassium estimation. Plasma osmolality was calculated.Results: Children with SM had higher frequency of hyponatremia and hypokalemia than children with uncomplicated malaria (UM). Hyperkalemia complicated 10.7% of cases of SM. Children with SM had lower creatinine and plasma osmolality than those with UM. Children presenting with more than one of the complications, showed higher plasma osmolality, urea levels and creatinine levels than those with UM. Conclusions: Hyponatremia may reflect the syndrome of inappropriate ADH secretion. Hypokalemia is a frequent complication while hyperkalemia complicates some cases. Dehydration may play a role in renal impairment; thus fluid therapy is indicated in cases with evidence of dehydration