Salty Saga of Hyponatremia and Hypotension in the PICU

Today, Dr. Monica Gray, Dr. Pradip Kamat, and Dr. Rahul Damania discuss two real-life pediatric cases of hyponatremia in the PICU. They talk through a case of a six-month-old baby with severe sodium depletion and a teenager dealing with cancer-related hyponatremia. The team breaks down the pathophysiology, walks us through the diagnostic workups, and discusses the careful management needed for these cases. They emphasize the importance of correcting sodium levels gradually and addressing the root cause of the problem. They share practical tips for intensivists and highlight why staying vigilant and following evidence-based care is so crucial when managing critically ill kids with electrolyte disturbances. Tune in to hear more!

Show Highlights:

• Discussion of hyponatremia in pediatric patients, particularly in the PICU
• Presentation of two case studies illustrating different presentations of hyponatremia
• Examination of the pathophysiology of hyponatremia, including its classification into hypovolemic, euvolemic, and hypervolemic types
• Overview of diagnostic investigations for hyponatremia, including volume status assessment and serum/urine electrolyte measurements
• Management strategies for hyponatremia, emphasizing the importance of gradual correction of sodium levels
• Risks associated with rapid correction of hyponatremia
• Importance of fluid management in different types of hyponatremia
• Role of pharmacological interventions in specific cases, such as SIADH
• Clinical presentation and symptoms associated with hyponatremia in pediatric patients
• Emphasis on continuous monitoring of sodium levels and clinical status during treatment

References:

• Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter 71. Fluid and electrolyte issues in pediatric critical illness. Evans I, Joyce E. Page 866-872
• Rogers' textbook of Pediatric Intensive Care Chapter 108: Disorders of Water, Sodium and Potassium homeostasis: Schneider J & Glater-Welt L. Pages 1868-1880
• Harrison’s Principles of Internal Medicine Volume 1. Chapter 53: Fluid and Electrolyte Disturbances. Mount D. Pages 338-347