FREQUENCY OF HYPONATREMIA

IN CHILDREN WITH ACUTE DIARRHEA TAKING LOW SMOLAR ORAL REHYDRATION SOLUTION

Abstract

Introduction: Acute diarrhea is defined as passage of three or more stools in a day, of consistency softer than usual for the
child, or one watery stool. Acute diarrhea is the major cause of morbidity and mortality in developing countries. It accounts for approximately
25% of total admissions in children ward and causes mortality of 5-10% in community. As dehydration is the main complication of diarrhea,
treatment focuses upon rehydration through fluid replacement. Oral Rehydration solution (ORS) is the recommended treatment in children with
acute diarrhea and some dehydration. Now WHO has recommended Low Osmolarity ORS which contains less sodium and glucose than
standard ORS. One of the side effect of use of ORS solution with reduced sodium level is the development of hyponatremia ( i.e. serum sodium
level less than 130 meq/L) in some of children with acute diarrhea and results in adverse clinical events. Objective: To determine the
frequency of hyponatremia in children taking low osmolarity ORS for management of acute diarrhea with some dehydration. Study design:
Descriptive case series. Place and Duration of Study: Study was conducted in Department of Pediatrics, Children ward-2 Bahawal Victoria
Hospital Bahawal Pur and Department of Pathology Quaid-e-Azam medical college Bahawal Pur from 7th August 2010 to 22nd September
2010. Subjects and methods: Total 32 children with age between 3 months to 60 months with acute diarrhoea and some dehydration with
normal initial serum sodium were included. An informed consent was taken from the parents to include their children in the study. Proforma was
filled at the time of admission and after 4 hours. Blood sample was taken to measure serum sodium level. Criteria of hyponatreima was serum
sodium level below 130 meq/l after giving low osmolarity ORS at a dose of 75 ml/kg to drink. Results: A total of 32 children with acute diarrhea
were included in study with age ranging from 3 months to 60 months. Male to female ratio was 1.1:1. Hyponatremia was seen in 2 (6.3%) of
patients. Conclusions: The risk of hyponatremia in patients treated with the low osmolarity ORS was minimal.