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Abstract

Objectives: Lower respiratory tract infection (LRTI) is an important cause of hospitalization in pediatric population. Hyponatremia is frequently present in children hospitalized with pneumonia and bronchiolitis and is associated with poorer outcomes. We conducted a study to identify the risk factors for hyponatremia in hospitalized children with LRTI and to evaluate the relationship between serum sodium levels and severity of respiratory distress. Methods: 147 patients between 2 months – 12 years of age, admitted with the diagnosis of LRTI at Mahatma Gandhi Mission’s Hospital & Medical College, a tertiary hospital in Navi Mumbai, India, between December 2017 to November 2019 were studied prospectively. Patients with any other comorbidities were excluded. The severity of respiratory distress at presentation was graded using the Clinical Respiratory Score (CRS). Serum electrolytes were sent within one hour of hospital admission. Results: Median age of enrolled patients was 14 months. 23(16%) children had mild respiratory distress, 97(66 %) had moderate respiratory distress and 26(18%) had severe distress. The incidence of hyponatremia in children admitted with LRTI was 66% and majority of them (70%) had mild hyponatremia. The incidence as well as severity of hyponatremia differed significantly with etiology (P<0.05). An inverse correlation was found between serum sodium levels and CRS at presentation (r = −0.26, P = 0.001). In multivariate analyses, parenchymal disease was an independent risk factor for development of hyponatremia (aOR = 5.64 (2.52 -12.59), P< 0.001). Conclusion: Incidence and severity of hyponatremia in children with LRTI increases with severity of respiratory distress and presence of parenchymal disease.

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