Hypernatraemic dehydration in children with acute gastroenteritis requiring intensive care in a tertiary hospital, Cape Town, South Africa.
Date
2023-11
Authors
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Publisher
Stellenbosch : Stellenbosch University
Abstract
ENGLISH ABSTRACT: Background: Limited data is available on the management and outcome of hypernatremia as complication of acute gastro-enteritis (AGE) in children requiring paediatric intensive care in the developing world, and Africa in particular. Objectives: To describe the proportion, management, morbidity and mortality of children admitted with AGE, and hypernatraemia, to the paediatric intensive care unit (PICU) at Tygerberg Hospital, South Africa. Methods: This is a retrospective descriptive study from 1 January 2015 to 31 December 2020. Data were obtained from the intensive care unit data base, the National Health Laboratory Services and hospital electronic patient records. Demographic-, clinical-, and laboratory data, with complication events and mortality were determined. Results: There were 251 admissions of children with AGE, a proportion, of 5.9%; with 195 included in the final data analysis. Hypernatraemia was recorded in 47.2% (92/195) of AGE admissions; these infants had a median age of 5 months, 76% (70/92) had normal weights for age on admission and 6% (6/92) were HIV infected. The median sodium (Na) on admission was 159 mmol/L (IQR 150-168), improving to a median of 147 mmol/L (IQR 142-152) after 48 hours of admission. The acidosis improved significantly within 48 hrs of admission (p<0.001). Seizures, hypocalcaemia, and hyperglycaemia were more common in the group with hypernatraemic dehydration. The majority (84%, 65/77) of hypernatraemic dehydration patients were managed with a chloride free solution during the first 24 hours of admission and two thirds (67%, 48/71) required intubation and ventilation before transfer to the PICU. Most children with AGE were referred from another hospital (79%, 154/195). Most children presented initially with severe dehydration (97%, 190/195) and shock (89%,174/195); half (49%, 96/195) were still shocked on admission to PICU. Overall, the mortality rate in children admitted with acute gastro-enteritis was 7.2% (14/195); it was 4.3% (4/92) in the hypernatremic, 5.7% (4/69) in the isonatremic, and 17.6% (6/34) in the hyponatraemic dehydration groups. All patients who died (100%, 14/14) required intubation and ventilation before transfer, with a third (36%, 5/14) having coinciding sepsis with a positive blood culture. Most deaths in the hypernatraemic and isonatraemic dehydration groups occurred within the first 2 days of admission, with deaths in the hyponatraemic group occurring later. Conclusion: Complicated AGE remains a significant contributing factor to child morbidity and mortality in South Africa irrespective of the blood sodium level, but hypernatremia was not the major contributor as expected from the literature. Infants younger than 1 year of age, those with underlying malnutrition and sepsis, and those requiring intubation and ventilation at the referring facility may be at highest risk of death.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.
Description
Thesis (MMed)--Stellenbosch University, 2023.