Alakeel Yousif S, Alkahtani Meshary M, Hijazi Omar M, Algahtani Mohammad M
College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
Saudi Pharm J. 2022 Aug;30(8):1107-1112. doi: 10.1016/j.jsps.2022.06.006. Epub 2022 Jun 13.
The association of hyponatremia with vasopressin therapy in children is controversial. We aimed to evaluate the incidence and severity of hyponatremia associated with the administration of vasopressin in critically ill pediatric patients.
This retrospective cross-sectional study included children younger than 14 years who were admitted to the pediatric or pediatric cardiac intensive care units and received vasopressin for at least 24 h.
In total, 176 critically ill pediatric patients were enrolled, with a median age of 22 days (7.3-146). The mean sodium level was notably decreased from 143.5 mEq/L ± 7.15 at the baseline to 134.3 mEq/L ± 7.7 at the 72-hour measurement after the initiation of vasopressin and varied significantly at all intervals from the baseline measurement ( < 0.001). Twenty-four hours after the discontinuation of vasopressin, more than half of the patients had hyponatremia. The highest proportion had mild hyponatremia (32.8%), followed by moderate hyponatremia (13.1%), and profound hyponatremia (7.5%). The incidence of hyponatremia was independent of gender (P = 0.94) or age group (P = 0.087). However, more than two-thirds of the moderate-profound cases and more than one-third of mild cases were observed in the neonate group (P = 0.043). The vasopressin dose did not affect the incidence ( = 0.25) or the severity of the hyponatremia ( = 0.56). Notably, all laboratory and hemodynamic parameters varied significantly at the end of therapy, compared to the baseline.
Continuous monitoring for hyponatremia when children are placed on vasopressin is essential to protect against more severe complications.
低钠血症与儿童血管加压素治疗之间的关联存在争议。我们旨在评估危重症儿科患者使用血管加压素后低钠血症的发生率和严重程度。
这项回顾性横断面研究纳入了14岁以下入住儿科或儿科心脏重症监护病房且接受血管加压素治疗至少24小时的儿童。
总共纳入了176例危重症儿科患者，中位年龄为22天（7.3 - 146天）。血管加压素开始使用后，平均钠水平从基线时的143.5 mEq/L ± 7.15显著降至72小时测量时的134.3 mEq/L ± 7.7，且在所有与基线测量的时间间隔内均有显著变化（P < 0.001）。血管加压素停用24小时后，超过一半的患者出现低钠血症。比例最高的是轻度低钠血症（32.8%），其次是中度低钠血症（13.1%）和重度低钠血症（7.5%）。低钠血症的发生率与性别（P = 0.94）或年龄组（P = 0.087）无关。然而，在新生儿组中观察到超过三分之二的中度 - 重度病例和超过三分之一的轻度病例（P = 0.043）。血管加压素剂量不影响低钠血症的发生率（P = 0.25）或严重程度（P = 0.56）。值得注意的是，与基线相比，治疗结束时所有实验室和血流动力学参数均有显著变化。
儿童使用血管加压素时持续监测低钠血症对于预防更严重的并发症至关重要。
