Hyponatremia and Hypotonic Intravenous Fluids Are Associated With Unfavorable Outcomes of Bronchiolitis Admissions

Steven L. Shein, Katherine Slain, Natalia Martinez Schlurmann, Richard Speicher, Alexandre T. Rotta

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

OBJECTIVES: Hyponatremia has been associated with unfavorable outcomes when present at admission in children with bronchiolitis. Delayed hyponatremia may be a modifiable risk factor for severe disease that is influenced by intravenous fluid (IVF) tonicity. We hypothesized that both hyponatremia and prescription of severely hypotonic IVF are associated with unfavorable outcomes, and that prescription of severely hypotonic IVF is associated with subsequent hyponatremia.

METHODS: Data were retrospectively extracted for 1557 pediatric inpatients with bronchiolitis. Any day on which a subject was prescribed IVF with sodium <70 mEq/L was termed "IVF <70." All other days on which IVF was prescribed were termed "IVF ≥70." Any blood sodium ≤135 mEq/L defined hyponatremia for that day. All other days with sodium available were labeled normonatremia. Variables were compared with Spearman correlation, Wilcoxon rank test, or χ2. Significant results had P < .05.

RESULTS: Blood sodium levels correlated negatively with hospital length of stay (r = -0.477, P < .0001). On each of the first 4 days of hospitalization, significantly increased hospital length of stay was observed in patients with hyponatremia (n = 134 [25.7% of subjects with available sodium data]) versus patients with normonatremia (n = 387 [74.3%]), and in patients prescribed IVF <70 (n = 348 [46.3% of subjects prescribed IVF]) versus patients prescribed IVF ≥70 (n = 403 [53.7%]). Patients prescribed IVF <70 had increased rates of hyponatremia on the subsequent day versus patients prescribed IVF ≥70 (50.0% vs 26.9%, P < .001).

CONCLUSIONS: In children hospitalized with bronchiolitis, hyponatremia may be a modifiable risk factor for severe disease that may be mitigated by avoiding use of severely hypotonic IVF.

Original languageEnglish (US)
Pages (from-to)263-270
Number of pages8
JournalHospital pediatrics
Volume7
Issue number5
DOIs
StatePublished - May 1 2017
Externally publishedYes

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Bronchiolitis
Hyponatremia
Sodium
Length of Stay
Prescriptions
Hospitalized Child
Nonparametric Statistics
Inpatients
Hospitalization
Pediatrics

ASJC Scopus subject areas

  • Medicine(all)

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Hyponatremia and Hypotonic Intravenous Fluids Are Associated With Unfavorable Outcomes of Bronchiolitis Admissions. / Shein, Steven L.; Slain, Katherine; Martinez Schlurmann, Natalia; Speicher, Richard; Rotta, Alexandre T.

In: Hospital pediatrics, Vol. 7, No. 5, 01.05.2017, p. 263-270.

Research output: Contribution to journalArticle

Shein, Steven L. ; Slain, Katherine ; Martinez Schlurmann, Natalia ; Speicher, Richard ; Rotta, Alexandre T. / Hyponatremia and Hypotonic Intravenous Fluids Are Associated With Unfavorable Outcomes of Bronchiolitis Admissions. In: Hospital pediatrics. 2017 ; Vol. 7, No. 5. pp. 263-270.
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T1 - Hyponatremia and Hypotonic Intravenous Fluids Are Associated With Unfavorable Outcomes of Bronchiolitis Admissions

AU - Shein, Steven L.

AU - Slain, Katherine

AU - Martinez Schlurmann, Natalia

AU - Speicher, Richard

AU - Rotta, Alexandre T.

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N2 - OBJECTIVES: Hyponatremia has been associated with unfavorable outcomes when present at admission in children with bronchiolitis. Delayed hyponatremia may be a modifiable risk factor for severe disease that is influenced by intravenous fluid (IVF) tonicity. We hypothesized that both hyponatremia and prescription of severely hypotonic IVF are associated with unfavorable outcomes, and that prescription of severely hypotonic IVF is associated with subsequent hyponatremia.METHODS: Data were retrospectively extracted for 1557 pediatric inpatients with bronchiolitis. Any day on which a subject was prescribed IVF with sodium <70 mEq/L was termed "IVF <70." All other days on which IVF was prescribed were termed "IVF ≥70." Any blood sodium ≤135 mEq/L defined hyponatremia for that day. All other days with sodium available were labeled normonatremia. Variables were compared with Spearman correlation, Wilcoxon rank test, or χ2. Significant results had P < .05.RESULTS: Blood sodium levels correlated negatively with hospital length of stay (r = -0.477, P < .0001). On each of the first 4 days of hospitalization, significantly increased hospital length of stay was observed in patients with hyponatremia (n = 134 [25.7% of subjects with available sodium data]) versus patients with normonatremia (n = 387 [74.3%]), and in patients prescribed IVF <70 (n = 348 [46.3% of subjects prescribed IVF]) versus patients prescribed IVF ≥70 (n = 403 [53.7%]). Patients prescribed IVF <70 had increased rates of hyponatremia on the subsequent day versus patients prescribed IVF ≥70 (50.0% vs 26.9%, P < .001).CONCLUSIONS: In children hospitalized with bronchiolitis, hyponatremia may be a modifiable risk factor for severe disease that may be mitigated by avoiding use of severely hypotonic IVF.

AB - OBJECTIVES: Hyponatremia has been associated with unfavorable outcomes when present at admission in children with bronchiolitis. Delayed hyponatremia may be a modifiable risk factor for severe disease that is influenced by intravenous fluid (IVF) tonicity. We hypothesized that both hyponatremia and prescription of severely hypotonic IVF are associated with unfavorable outcomes, and that prescription of severely hypotonic IVF is associated with subsequent hyponatremia.METHODS: Data were retrospectively extracted for 1557 pediatric inpatients with bronchiolitis. Any day on which a subject was prescribed IVF with sodium <70 mEq/L was termed "IVF <70." All other days on which IVF was prescribed were termed "IVF ≥70." Any blood sodium ≤135 mEq/L defined hyponatremia for that day. All other days with sodium available were labeled normonatremia. Variables were compared with Spearman correlation, Wilcoxon rank test, or χ2. Significant results had P < .05.RESULTS: Blood sodium levels correlated negatively with hospital length of stay (r = -0.477, P < .0001). On each of the first 4 days of hospitalization, significantly increased hospital length of stay was observed in patients with hyponatremia (n = 134 [25.7% of subjects with available sodium data]) versus patients with normonatremia (n = 387 [74.3%]), and in patients prescribed IVF <70 (n = 348 [46.3% of subjects prescribed IVF]) versus patients prescribed IVF ≥70 (n = 403 [53.7%]). Patients prescribed IVF <70 had increased rates of hyponatremia on the subsequent day versus patients prescribed IVF ≥70 (50.0% vs 26.9%, P < .001).CONCLUSIONS: In children hospitalized with bronchiolitis, hyponatremia may be a modifiable risk factor for severe disease that may be mitigated by avoiding use of severely hypotonic IVF.

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