Abstract
Studies focusing on serum sodium disorders in children with community-acquired-pneumonia (CAP) are nearly entirely lacking, though clinical experience suggests that at least hyponatremia (HN) might be rather common. We evaluated the incidence of hypo- and hypernatremia, in relation to other clinical, laboratory and etiological findings, in pediatric CAP. Serum sodium concentration was measured in 108 ambulatory and hospitalized children with radiologically confirmed CAP of variable severity. The etiology of CAP was revealed by serology in 97 patients. HN (serum sodium < 135 mmol/l) was present in 49 (45.4%) children, and it was mild (> 130 mmol/l) in 92% of the cases. On admission, hyponatremic patients had higher body temperature (38.96°C vs 38.45°C, P = 0.008), white blood cell count (21,074/μl vs 16,592/μl, P = 0.008), neutrophil percentage (78.93% vs 69.33%, P = 0.0001), serum C-reactive protein (168.27 mg/l vs 104.75 mg/l, P = 0.014), and serum procalcitonin (22.35 ng/ml vs 6.87 ng/ml, P = 0.0001), and lower calculated osmolality (263.39 mosmol/l vs 272.84 mosmol/l, P = 0.0001) than normonatremic ones. No association was found with plasma glucose, type of radiological consolidation or etiology of CAP. HN is common but usually mild in children with CAP. HN seems to be associated with the severity of CAP, assessed by fever, need of hospitalization and serum non-specific inflammatory markers.
References
Moritz ML, Ayus JC (2002) Disorders of water metabolism in children: hyponatremia and hypernatremia. Pediatr Rev 23:371–380
Oh MS (2002) Pathogenesis and diagnosis of hyponatremia. Nephron 92 [Suppl 1]:2–8
Adroguè HJ, Madias N (2000) Hyponatremia. N Engl J Med 342:1581–1589
Kumar S, Berl T (1998) Sodium. Lancet 353:220–228
Smith DM, McKenna K, Thompson CJ (2000) Hyponatraemia. Clin Endocrinol 52:667–678
Ellison DH, Berl T (2007) The syndrome of inappropriate antidiuresis. N Engl J Med 356:2064–2072
Valerio G, Franzese A, Carlin E, Pecile P, Perini R, Tenore A (2001) High prevalence of stress hyperglycaemia in children with febrile seizures and traumatic injuries. Acta Paediatr 90:618–622
Gupta P, Natarajan G, Agarwal KN (1997) Transient hyperglycemia in acute childhood illnesses: to attend or ignore? Indian J Pediatr 64:205–210
Bhisitkul DM, Morrow AL, Vinik AI, Shults J, Layland JC (1994) Prevalence of stress hyperglycemia among patients attending a pediatric emergency department. J Pediatr 124:547–551
Katz MA (1973) Hyperglycemia-induced hyponatremia: calculation of expected serum sodium depression. N Engl J Med 289:843–844
Hillier TA, Abbott RD, Barrett E (1999) Hyponatremia: evaluating the correction factor for hyperglycemia. Am J Med 106:399–403
Stormont JM, Waterhouse C (1962) Severe hyponatraemia associated with pneumonia. Metabolism 11:1181–1186
Shann F, Germer S (1985) Hyponatraemia associated with pneumonia or bacterial meningitis. Arch Dis Child 60:963–966
Singhi S, Dhawan A (1992) Frequency and significance of electrolyte abnormalities in pneumonia. Indian Pediatr 29:735–740
Dhawan A, Narang A, Singhi S (1992) Hyponatraemia and the inappropriate ADH syndrome in pneumonia. Ann Trop Paediatr 12:455–462
Nair V, Niederman MS, Masani N, Fishbane S (2007) Hyponatremia in community-acquired pneumonia. Am J Nephrol 27:184–190
Don M, Fasoli L, Paldanius M, Vainionpää R, Kleemola M, Räty R, Leinonen M, Korppi M, Tenore A, Canciani M (2005) Etiology of community-acquired pneumonia: serologic results of a paediatric survey. Scand J Infect Dis 37:806–812
Don M, Paldanius M, Fasoli L, Canciani M, Korppi M (2006) Simkania negevensis is a rare but real cause of pneumonia in children. Pediatr Infect Dis J 25:470–471
Fasoli L, Paldanius M, Don M, Valent F, Vetrugno L, Korppi M, Canciani M (2008) Simkania negevensis in community-acquired pneumonia in Italian children. Scand J Infect Dis 40:269–272
Don M, Valent F, Korppi M, Falleti E, De Candia A, Fasoli L, Tenore A, Canciani M (2007) Efficacy of serum procalcitonin in evaluating severity of community-acquired pneumonia in childhood. Scand J Infect Dis 39:129–137
Don M, Valerio G, Korppi M, Canciani M (2008) Hyper- and hypo-glycaemia in children with community-acquired pneumonia. J Pediatr Endocrinol Metab (in press)
Milionis HJ, Liamis GL, Elisaf MS (2002) The hyponatremic patient: a systematic approach to laboratory diagnosis. CMAJ 166:1056–1062
Nohynek H, Eskola J, Kleemola M, Jalonen E, Saikku P, Leinonen M (1995) Bacterial antibody assays in the diagnosis of acute lower respiratory tract infection in children. Pediatr Infect Dis J 14:478–484
Kenny GE, Grayston JT (1965) Eaton pleuropneumonia-like organism (Mycoplasma pneumoniae) complement-fixing antigen: extraction with organic solvents. J Immunol 95:19–25
Korppi M, Heiskanen-Kosma T, Kleemola M (2004) Incidence of community-acquired pneumonia in children caused by Mycoplasma pneumoniae: serological results of a prospective, population-based study in primary health care. Respirology 9:109–114
Persson K, Boman J (2000) Comparison of five serologic tests for diagnosis of acute infections by Chlamydia pneumoniae. Clin Diagn Lab Immunol 7:739–744
Wang S (2000) The microimmunofluorescence test for Chlamydia pneumoniae infection: technique and interpretation. J Infect Dis 181 [Suppl 3]:S421–S425
Vuorinen T, Meurman O (1989) Enzyme immunoassays for detection of IgG and IgM antibodies to parainfluenza types 1, 2 and 3. J Virol Methods 23:63–70
Ziegler T, Lindholm T, Scalia G (1989) Causes of false-positive reactions in herpesvirus IgM assays. Serodiagn Immunother Infect Dis 3:101–109
Laine M, Vainionpää R, Uksila J, Oksi J, Nissila M, Kaarela K, Luukkainen R, Toivanen A (2003) Prevalence of Sindbis-related (Pogosta) virus infections in patients with arthritis. Clin Exp Rheumatol 21:213–216
Torres JM, Cardenas O, Vasquez A, Schlossberg D (1998) Streptococcus pneumoniae bacteremia in a community hospital. Chest 113:387–390
Haviv M, Haver E, Lichtstein D, Hurvitz H, Klar A (2005) Atrial natriuretic peptide in children with pneumonia. Pediatr Pulmonol 40:306–309
Gerigk M, Gnehm HE, Rascher W (1996) Arginine vasopressin and renin in acutely ill children: implication for fluid therapy. Acta Paediatr 85:550–553
Abe Y, Watanabe T (2003) Pertussis pneumonia complicated by a hyponatremic seizure. Pediatr Emerg Care 19:262–264
Pedro-Botet ML, Sopena N, García-Cruz A, Mateu L, García-Núñez M, Rey-Joly C, Sabrià M (2007) Streptococcus pneumoniae and Legionella pneumophila pneumonia in HIV-infected patients. Scand J Infect Dis 39:122–128
Sopena N, Pedro-Botet ML, Sabrià M, García-Parés D, Reynaga E, García-Nuñez M (2004) Comparative study of community-acquired pneumonia caused by Streptococcus pneumoniae, Legionella pneumophila or Chlamydia pneumoniae. Scand J Infect Dis 36:330–334
Sopena N, Sabrià-Leal M, Pedro-Botet ML, Padilla E, Dominguez J, Morera J, Tudela P (1998) Comparative study of the clinical presentation of Legionella pneumonia and other community-acquired pneumonias. Chest 113:1195–1200
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Don, M., Valerio, G., Korppi, M. et al. Hyponatremia in pediatric community-acquired pneumonia. Pediatr Nephrol 23, 2247–2253 (2008). https://doi.org/10.1007/s00467-008-0910-2
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DOI: https://doi.org/10.1007/s00467-008-0910-2