ABSTRACT
The aim of the study was to elucidate a relationship between the development of hypernatremia and the frequency of poor outcomes in children with severe brain injury (SBI). The retrospective study enrolled 77 children (54 boys and 23 girls) aged 1 month to 18 years, who had SBI in the period of January 2008 to September 2009, and were divided into 3 groups after treatment termination. The admission injury severity criterion was Glasgow coma scale (8 scores or less) rating. Group A comprised 51 children with SBI without hypernatremia; Group B included 14 children with SBI and hypernatremia. Group C consisted of 12 children with SBI, hypernatremia, and polyuremia. The latter group was appraised as a group with evolving central diabetes insipidus. A total of 26 (33.8%) patients had hypernatremia. Poor outcomes (Glasgow outcome scores of 1-3) at 30 days were noted in only Groups B and C: comparison of outcomes in Groups B and C showed the higher incidence of poor outcomes in 10 (84%) Group C patients (with hypernatremia and polyuria) and 4 (28%) children in Group B. Comparison of Groups B and C children indicated that the hazard ratio was 0.3. Therefore, the risk of poor outcomes is much higher in the development of central diabetes insipidous in the presence of hypernatremia.
Subject(s)
Brain Injuries/blood , Hypernatremia/blood , Sodium/blood , Adolescent , Antidiuretic Agents/administration & dosage , Antidiuretic Agents/therapeutic use , Brain Injuries/complications , Brain Injuries/physiopathology , Case-Control Studies , Child , Child, Preschool , Deamino Arginine Vasopressin/administration & dosage , Deamino Arginine Vasopressin/therapeutic use , Diabetes Insipidus, Neurogenic/blood , Diabetes Insipidus, Neurogenic/epidemiology , Diabetes Insipidus, Neurogenic/etiology , Diabetes Insipidus, Neurogenic/prevention & control , Female , Glasgow Coma Scale , Humans , Hypernatremia/epidemiology , Hypernatremia/etiology , Hypernatremia/prevention & control , Infant , Intracranial Pressure/drug effects , Intracranial Pressure/physiology , Male , Polyuria/blood , Polyuria/epidemiology , Polyuria/etiology , Polyuria/prevention & control , Predictive Value of Tests , Retrospective StudiesABSTRACT
The paper describes the authors' experience in using prolonged venovenous hemofiltration in the complex treatment of children with severe thermal injury complicated with multiple organ dysfunction, showing the higher efficiency of treatment in patients with the above condition and the reduction in the number of complications and mortality. This technique is not limited by renal function replacement.
