A Study of Hyponatremia in Lower Respiratory Infections in Children Aged 2months to 5 Years

We studied serum sodium levels within 2 hours of admission of 100 children aged 2months to 5 years admitted with diagnosis of lower respiratory infections(pneumonia,bronchiolitis, bronchitis, empyema and WALRI). Methods: In our study out of these 100 cases 33(33%) cases were having hyponatremia (s.sodium<135mEq/L) &0ut of33(33%) cases 17(51.5%) cases had mild hyponatremia i.e. s.sodium 131-134mEq/L, 14(42.5%) cases had moderate hyponatremia i.e. s.sodium 126-130mEq/L & 2(6%)cases had severe hyponatremia i.e. s.sodium <125mEq/L. These Children with hyponatremia were evaluated for plasma osmolality, urinary sodium and osmolality on day of admission and after appropriate fluid therapy. Results: Out of these 33 cases, the probable cause of hyponatremia was the syndrome of inappropriate secretion of antidiuretic hormone in 27(81.8%) cases (as suggested by their plasma osmolality,urinary sodium and urine osmolality). Symptoms and signs indicative of severe LRIs were about one and a half times more frequent and the mean duration of hospital stay was 49.2% longer in children with hyponatremia than with isonatremia. Two children (2%) with severe hyponatremia had complications in the form of convulsions associated with transitory altered sensorium for 2-3 days. The recovery from hyponatremia with timely intervention showed a good improvement in clinical symptomology of respiratory distress and there was no mortality in the studied cases. Conclusion: Thus it is concluded that,presence of hyponatremia in LRI’s increases the morbidity of these patients in the form of prolonged hospital stay and occurrence of complications like seizures followed by deranged sensorium in some cases.

Hypoglycemia in Neonates More than 1500 Gram Weight with No Secondary Cause – Its Effects and Outcome

Aim: 1) To study the outcome of hypoglycemia in neonates weighing >1500gram both symptomatic and asymptomatic having exclusively hypoglycemia with no any other medical condition known to cause brain damage , till 9 months of corrected gestational age(CGA).2) To study the clinical profile of hypoglycemia in neonates weighing >1500gram. Methods: 35 neonates weighing >1500gram with hypoglycemia (<40 mg/dl), both symptomatic and asymptomatic without any other medical condition known to cause brain damage were enrolled in the study. Hypoglycemia was confirmed with venous sample laboratory value. Both neonatal and maternal history was taken in detail, clinical examination, anthropometry was done. Follow up was done at 3, 6, 9 months of CGA for assessing neurodevelopmental outcome (motor developmental quotient i.e. MoDQ and mental developmental quotient i.e. MeDQ using DASII6 i.e. development assessment scale for Indian infants) and we did anthropometry and clinical examination, ultrasonography at discharge, electroencephalogram (EEG) done in patients with seizure, Magnetic Resonance Imaging (MRI) at 3 months, Brainstem evoked response audiometry (BERA) at 6 months, vision assessment at 9 months of CGA. Appropriate statistical analysis was done to calculate results. Results: Out of 35 enrolled cases follow up was possible in 30 cases. In our study, the prevalence of abnormal neurodevelopmental outcome according to DASII6 was 53.33% (n=16) cases with abnormal MoDQ (<70%) and 56.66% (n=17) cases with abnormal MeDQ (<70%) at 3, 6, 9 months of CGA respectively. There was statistically significant difference in the mean values of MoDQ (p value 0.014, 0.011, 0.02) and mean MeDQ (p value 0.019, 0.008, 0.02) on follow up at 3, 6, 9 months of corrected gestational age respectively between symptomatic and asymptomatic hypoglycemic cases. 8 (57.14%) symptomatic cases and 6 (37.5%) asymptomatic cases had microcephaly on follow up and the difference was not statistically significant. MRI was abnormal in 10 (71.4%) symptomatic cases and 6 (37.5%) asymptomatic cases and the difference was not statistically significant. Ultrasonography was done in all cases at discharge and it was found abnormal in 2(5.7%) cases. BERA, vision assessment and EEG was normal in all cases. Conclusion: Both symptomatic and asymptomatic hypoglycemia leads to abnormal neurodevelopmental outcome but it is more poor in symptomatic neonates as compared to asymptomatic hypoglycemia.