Kimberly Fenton, MD, FAAP,FCCM
Medical Director Pediatric Critical Care
AdventHealth for Children
Orlando, Florida
Disclosure information not submitted.
Amy Painter, ACNP, MSN, MSN
ACNP
AdventHealth for Children, United States
Disclosure information not submitted.
Title: Hyponatremia occurs frequently with Multi-System Inflammatory Syndrome in Children (MIS-C)
Introduction: MIS-C is associated with adverse outcomes in children following COVID-19 infection. Hyponatremia (HN) is associated with increased risks of morbidity and mortality in hospitalized patients including in adults with COVID-19 infections. There are some studies showing HN in COVID-19 infections. We describe the incidence of HN and presence of organ dysfunction in children with MIS-C.
Methods: A retrospective observational study was completed at a 200 bed children’s hospital within a larger hospital system. Data was collected from consecutive patients meeting the CDC case definition for MIS-C between April-October 2020. HN was defined as a serum sodium level < 135 mmol/L upon presentation to the Emergency Department or hospital admission (whichever was obtained first). Patients were assessed for the need for intensive care unit (ICU) admission, neurological sequalae (seizures or encephalopathy), presence of cardiac dysfunction (CD) by echocardiogram (defined by ejection fraction < 55%) and acute kidney injury (AKI) defined by elevated creatinine for age. Descriptive analysis was utilized by measure of frequency.
Results: 30 patients met the CDC case definition of MIS-C during the study time period. 12 of the 30 patients (40%) were hyponatremic upon admission. Of those, 3 out of 12 patients (25%) had sodium levels ≤130 mmol/L and 9 out of 12 patients (75%) had sodium levels of 131-134 mmol/L. 10 out of 12 patients (83%) with HN required ICU care while 12 out of 18 patients (67%) with normal sodium values required ICU care. 2 patients (17%) with HN had seizures and/or encephalopathy while no patients with normal sodium values did. 7of 12 patients (58%) with HN had CD and 8 of 12 (67%) had an AKI. Patients with normal sodium values had CD in 4 of 18 patients (22%) and AKI in 3 of 18 patients (17%)
Conclusions: HN occurs frequently in children with MIS-C upon hospital admission. In our population, patients with HN more frequently required ICU care, had a higher frequency of CD and a higher frequency of AKI than patients with normal sodium values. However further studies are necessary to delineate association and causality.
References: Frontera JA and Valdes, E et al: Prevalence and Impact of Hyponatremia in patients with coronavirus disease 2019 in New York City. Crit Care Med 2020