Hyponatremia in Children with Acute Lymphoblastic Leukemia

Özet

Aim: Hyponatremia is a common electrolyte abnormality in hospitalized patients. Administration of isotonic maintenance fluids isrecommended to prevent hyponatremia. The present study was conducted to evaluate the frequency and severity of hyponatremia in childrenwith acute lymphoblastic leukemia (ALL).Materials and Methods: The frequency, severity and possible causes of hyponatremia in children with ALL throughout their entire intensivetreatment were retrospectively evaluated. All children in this study received isotonic fluids as maintenance IV treatment during thehospitalization period.Results: In a five-year period, 618 hyponatremia episodes seen in 92 children with ALL (median age 59 months), treated with ALLIC 2002 protocolwere entered into the study. The median number of hyponatremia episodes per patient was 6. All patients had at least one hyponatremia episodeof which 83.2% were classified as mild, 13.2% as moderate, 2.9% as severe and 0.6% as very severe. The median duration of hyponatremiaepisodes was 5 (range between 1-43) days. The total duration of all hyponatremia episodes of each patient varied from 6 to 138 days with amedian of 30 days. In 241 episodes of 68 children, there was inadequate salt intake secondary to oral feeding intolerance, nausea, vomiting andoral aphthous stomatitis. In four patients, seizure was seen during the hyponatremia period and thought to be secondary to hyponatremicencephalopathy. No patient developed central pontine myelinolysis.Conclusion: Hyponatremia is very frequent in ALL patients. Despite the use of isotonic IV fluids, it seems it cannot be completely prevented.