The differential diagnosis of hypernatraemia in children, with ...

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The Diagnosis of Salt Poisoning Leading to Hypematraemia in Children – September 2009 A second cross sectional study from Spain investigated the relationship between 24 hour urinary excretion and blood pressure. 299 Results were expressed as means and standard deviations. Results were as follows: Age Sodium (mean +- SD) Number Sex 6-7 yrs 159 +- 30 mmol/day 52 Male 6-7 yrs 142 +- 30 mmol/day 55 Female 10 & 11 yrs 146 +- 34 mmol/day 103 Male 10 & 11 yrs 144 +- 26 mmol/day 90 Female 13-14 yrs 170 +- 40 mmol/day 67 Male 13-14 yrs 162 +- 30 mmol/day 74 Female Although children were weighed, their sodium excretion rates were not expressed by weight. A study from 19 centres across 14 European countries 300 on boys of 8 and 9 years of age reported the 24 hour urinary sodium output as means and standard errors of the mean, expressed as mmols per 24 hours. Mean 24 hour urinary sodium excretions from the different centres varied from 91 to 146 mmols. These were not expressed by body weight. A separate study from Vienna 301 reported on 24 hour urinary sodium excretion rates in 43 boys and 29 girls of 8 and 9 years of age. They found mean 24 hour sodium excretions of 160 and 165 mmols per day respectively and standard deviations of 19 and 18 mmols. They also reported ranges of 65 to 288 mmols in boys and 62 to 291 mmols in girls, demonstrating an enormous variation between apparently healthy individual children. A study from Chicago 302 included results of the 24 hour urinary sodiums obtained in healthy 11 to 14 year olds from 2 schools. Each individual collected their urine passed on each of 7 consecutive days, and the results presented as means and standard deviations both by day of the week and as overall mean values for the 7 days. The pooled mean 24 hour sodium was 133 mEq/L, with a standard deviation of 43.5 mEq/L. This would not serve as a good reference for normal ranges as it is a pooled result, each child having contributed 7 samples. A study measuring the daily urinary electrolyte excretion in 74 children aged 5 to 12 years in Ghana presenting for surgery 303 reported a mean 24 hour urinary sodium excretion rate of 4.6 mmol per kilogram body weight/day. Unfortunately 85
The Diagnosis of Salt Poisoning Leading to Hypematraemia in Children – September 2009 only the mean daily loss was reported. Thirty-nine of these children were studied around 4 to 5 days postoperatively, having mostly had an appendicectomy. An intervention study in Massachusetts 304 investigated the effects of supplementing the sodium intake of 191 9 th to 12 th grade girls in two schools (ages likely to be between 14 and 18 years) by 0.8 grams per day (2 grams of salt) for 8 weeks in a blinded randomised trial. Sodium excretion was only expressed as the change from baseline. A study investigating urinary calcium excretion in 89 healthy girls 305 also measured 24 hour urinary sodium. Urinary sodium was expressed as mg/day, but it was not possible to calculate excretion rate per body weight. Evidence statement 24 hour urinary sodium excretion rates of up to 11 mmol per kilogram per day have been observed in infants with salt poisoning. In view of the small number of cases reported and the absence of published normal values, particularly in infants, a cut off point above which excessive sodium intake can be inferred cannot be given. [Grade D] Evidence statement Further research into sodium excretion rates in normal infants and children and those with other causes of hypernatraemia including hypernatraemic dehydration are recommended. 6.2.4 Use of weight change to assess dehydration The use of weight change has been used as the ‘gold standard’ in studies assessing the effectiveness of various clinical criteria in determining the degree of dehydration in children with gastroenteritis. Weight after recovery correlates very well with pre-illness weight. Therefore accurate admission and post-recovery weights together provide a reliable method for determining the degree of dehydration in children. 27 86
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The Differential Diagnosis of Hyper
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