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  • Poster presentation
  • Open Access

Hypernatremia in pediatric patients with severe traumatic brain injury

  • 1,
  • 2,
  • 1 and
  • 2
Critical Care201014 (Suppl 1) :P291

https://doi.org/10.1186/cc8523

  • Published:

Keywords

  • Traumatic Brain Injury
  • Pediatric Patient
  • Emergency Medicine
  • Outcome Rate
  • Diabetes Insipidus

Introduction

Water-electrolyte imbalance and endocrine disorders make the problem of maintaining patients with severe traumatic brain injury (TBI) more difficult. A plasma sodium level ≥160 mmol/l is associated with 75% mortality. The purpose of this investigation was to find the relationship between hypernatraemia and the rate of unfavorable outcomes in children with TBI.

Methods

A total of 77 children <18 years of age with TBI (admission GCS score <8) were divided retrospectively into three groups: Group A included children without hypernatraemia (n = 51), Group B children with hypernatraemia (n = 14) and Group C (n = 12) children with hypernatraemia and polyuria. Group C was considered the group of patients with central diabetes insipidus (CDI). Hypernatraemia was defined as a twice elevation of the plasma sodium level over 149 mmol/l within 24 hours, while polyuria was defined as an increase in the hourly diuresis of more than 3 ml/kg/hour in no less than 6 hours.

Results

The mean sodium level at admission was 140.1 ± 4.1 mmol/l. Hypernatraemia was detected in 26 patients (33.8%). The mean duration of the period of hypernatraemia in Group B was 4 days (3 to 6 days), while the mean sodium level during the period of hypernatraemia was 158.3 ± 3.3 mmol/l (max 176.8 mmol/l). The duration of the period of hypernatraemia in Group C was 4.5 days with max 181.1 mmol/l and average 161 ± 4.7 mmol/l. Polyuria was diagnosed in 15.5% of the cases. The highest diuresis in this group was 4.1 mmol/kg/hour, mean 3.7 ± 0.5 ml/kg/hour. Such changes were considered a manifestation of CDI. All 12 patients in Group C received desmopressin (DDAVP) for more than 48 hours (mean 56.8 ± 4. 5 hours). The doses were 0.025 to 0.2 mg/day. In four out of 14 children in Group B (29%), an increase hourly diuresis up to 3 ml/kg/hour was considered the onset of CDI; thus, they were also prescribed DDAVP. Unfavorable outcomes (GOS score 1 to 3) during a 30-day assessment were observed only in Groups B and C. In a comparison of unsuccessful outcomes between Groups B and C, there was an increase in the unfavorable outcome rate in patients of Group C (with hypernatraemia and polyuria) - 10 children (84%) and Group B - four children (28%). The risk factor in the comparison between patients of Groups B and C was 0.3, P < 0.05.

Conclusions

Our results demonstrate that hypernatraemia increases the rate of unfavorable outcomes in children with TBI. Thirty-day outcomes were worse with CDI patients. Presumably, the used of DDAVP prevents dehydration and CDI advance.

Authors’ Affiliations

(1)
Speranskiy Children's Hospital, Moscow, Russia Federation
(2)
Moscow Research Institute of Pediatric Surgery, Moscow, Russia Federation

Copyright

© BioMed Central Ltd. 2010

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