Hyponatremia in children with severe pneumonia and its effect on overall outcome

Background: Severe pneumonia is often associated with dyselectrolytemia, most commonly hyponatremia and the level of sodium significantly correlates to the overall outcome of the patient. The present study was conducted to identify the incidence of hyponatremia in children with Severe Pneumonia and to identify its association with Syndrome of Inappropriate secretion of Anti Diuretic Hormone (SIADH) and the effect on morbidity, mortality and duration of hospital stay.Methods: This study was conducted on 102 children between the age group of 6 months to 5 years admitted to the Upgraded Department of Pediatrics, Patna Medical College and Hospital with clinically and radiologically confirmed severe pneumonia from March 2017 to September 2018.Results: There were 33(32.4%) cases of hyponatremia out of which 26(25.5%), 5(4.9%) and 2(1.9%) had mild, moderate and severe hyponatremia respectively. 19(57.6%) cases of hyponatremia were due to SIADH out of which the duration of hospital stay was prolonged in 10(52.6%) cases, 10(52.6%) cases developed complications and 7(36.8%) patients died. The mortality of patients with hyponatremia was significantly higher (p<0.05) in the group with SIADH when compared to those without SIADH. The average duration of stay in hospital also was significantly higher (p<0.05) for the group with hyponatremia i.e. 8.2'4.5 days when compared to the group with normnatremia i.e. 7.3'1.7 days.Conclusions: Hyponatremia is commonly associated with Severe Pneumonia. Hyponatremia is usually mild and results in prolonged hospital stay, increased complications and mortality especially when associated with SIADH.

Acute Intermittent Porphyria: A rare cause of hyponatraemia

@#Introduction: Hyponatraemia is one of the most frequent laboratory findings in hospitalised patients. We present an unusual case of hyponatraemia in a 23-year-old female secondary to acute intermittent porphyria (AIP), a rare inborn error of metabolism. Case Report: The patient presented with upper respiratory tract infection, fever, seizures and abdominal pain. An initial diagnosis of encephalitis was made. In view of the unexplained abdominal pain with other clinical findings such as posterior reversible encephalopathy syndrome by CT brain, temporary blindness as well as hyponatraemia, acute intermittent porphyria was suspected. Urine delta aminolaevulinic acid (δ-ALA) and porphobilinogen were elevated confirming the diagnosis of AIP. Genetic studies were done for this patient. The patient had a complete resolution of her symptoms with carbohydrate loading and high caloric diet. Conclusion: Although rare, AIP should be considered as a cause of hyponatraemia in a patient who presents with signs and/or symptoms that are characteristic of this disease.