Table of Contents

HK J Paediatr (New Series)
Vol 25. No. 3, 2020

HK J Paediatr (New Series) 2020;25:137-147

Original Article

Hyponatraemia in Hospitalised Children: A Retrospective Survey in Acute Paediatric Admissions in Hong Kong with Focus on Intravenous Fluid Practices

LCK Leung, KC Chan, WKY Chan, YK Ng, LY So, CM Chow, ALT Ma, G Tong, OY Wong, EYL Poon, MK Tay, KM Cheung, PM Tang, SY Lam


Purpose: Recent intravenous fluid (IVF) guidelines advocate empirical isotonic maintenance fluids in children to prevent potentially dangerous hyponatraemia. To see if this practice is appropriate for Hong Kong, we aimed to review the frequency and nature of hyponatraemia in acute paediatric settings, and its association with hypotonic IVF usage. Methods: Using Hospital Authority CDARS, we identified all public hospitalisation episodes of children aged 1 month to 18 years with hyponatraemia (Na<135 mmol/L) during 2015. Those with severe hyponatraemia (Na<127 mmol/L) had their clinical details and IVF use analysed. Findings: Hyponatraemia occurred in 8.8% of 60,960 paediatric admissions. True severe hyponatraemia occurred in 0.22% of all admissions, with 56% occurring at admission. Five cases had hyponatraemic seizures. Of 110 cases with hypovolaemic or euvolaemic severe hyponatraemia, 22 cases of hospital-acquired hyponatraemia were identified where hypotonic fluids likely contributed, as replacement, hyperhydration or maintenance fluids. Conclusions: Serious hyponatraemia may occur in association with hypotonic IVF. Paediatricians must prescribe IVF with care. Safe prescription practices are discussed.

目的:近期靜脈輸液指南提倡對兒童經驗性等張維持液體治療,以預防潛在的危害性低鈉血症。為瞭解此操作在香港應用是否恰當,作者就此對兒童急診入院病例中的低鈉血症發生率和病情,及其與低張性靜脈輸液的相關性,進行綜合回顧。方法:作者經香港醫院管理局CDARS(臨床數據分析及記錄系統)查出2015年度所有公立醫院住院中,年齡1個月至18歲病人患有低鈉血症(Na<135 mmol/L)的例次。對其中的重度低鈉血症(Na<127 mmol/L)的病例,進行臨床細節和靜脈輸液使用情況分析。結果:低鈉血症見於8.8%的60,960例兒童入院病例。真正重度低鈉血症見於0.22%的所有入院病例,其中56%發生於入院時。低鈉血症性驚厥有5例。在低容量或容積性重度低鈉血症110例中,22例為院內獲得性低鈉血症。其中作為補充液體損失、水化過量和維持液體治療,低張性液體治療可能導致其發生。結論:嚴重低鈉血症的發生可與低張性靜脈輸液有關。兒科醫生必須細心開處靜脈輸液治療。文中也論及安全處方的規範。

Keyword : Hyponatraemia; Hypotonic fluid; Intravenous fluid; Paediatric



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