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Abstract: TH-OR31

Rapid Correction of Hypernatremia Is Not Associated With Mortality or Neurological Morbidity in Children: The Correcting Hypernatremia in Children Study

Session Information

Category: Pediatric Nephrology

  • 1800 Pediatric Nephrology

Authors

  • Didsbury, Madeleine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  • See, Emily, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  • Cheng, Daryl R., The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  • Kausman, Joshua Y., The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  • Quinlan, Catherine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
Background

In patients with hypernatremia current guidelines recommend reducing sodium by <0.5mmol/L per hour to avoid cerebral edema, however there are no large-scale studies in the pediatric population. This study aimed to examine the rate of correction of hypernatremia, neurological outcomes, and mortality in children.

Methods

A retrospective review was conducted using the electronic medical record at a quaternary pediatric hospital to capture all children with at least one sodium level of ≥150mmol/L from 2016-2019.
Electroencephalogram results, neuroimaging and medical records were reviewed manually for seizures and cerebral edema. Correction rates over the first 24 hours and overall were calculated from the peak sodium and defined as rapid (>0.5mmol/L) or slow (<0.5mmol/L per hour). Binary, univariable and multivariable analyses were used to examine the association between the rate of correction and need for neurological investigation and death.

Results

There were 402 episodes of hypernatremia amongst 358 children over three years. 179 were community-acquired and 223 developed during admission. 28 patients (7%) died during admission. Compared to those with community-acquired hypernatremia, patients with hospital-acquired hypernatremia had higher mortality (10% vs 4%, p=0.02), more intensive care unit (ICU) admissions (63% vs 51%, p=0.01), and a longer length of stay (20.7 vs 7.2 days, p<0.001). Rapid correction occurred in 200 children and was not associated with increased mortality (OR 0.54, 95% CI 0.24 to 1.2, p=0.13) or neurological investigation (OR 0.89, 95% CI 0.55 to 1.46, p=0.65) compared to slow correction. Findings were consistent when examined with the correction rate as a continuous variable and by age subgroups. Both hospital and ICU length of stay were longer in children who received slow correction (median days in hospital 24.9 vs 15.9, p=0.009; median days in ICU 11.3 vs 8.5, p=0.03).

Conclusion

We did not find any evidence that rapid sodium correction was associated with neurological morbidity or mortality; however slow correction was associated with a longer length of stay. Further prospective studies are needed to confirm the safety and advantages of rapid correction in children.