Dilek KONUKSEVER, Sevinç Püren YÜCEL KARAKAYA

Çocuk Acil Kliniğinde Sodyum ve Potasyum Bozuklukları: Tek Merkez Deneyimi

Amaç: Bu çalışmada çocuk acil servis başvurularında sodyum ve potasyum bozuklukları spektrumunun incelenmesi amaçlanmıştır. Gereç ve Yöntemler: Araştırmamız kesitsel ve tek merkezlidir. 2017-2020 yılları arasında çocuk acil kliniğine herhangi bir nedenle başvurup tetkiklerinde sodyum ve/veya potasyum bozukluğu tespit edilen, 18 yaşından küçük hastalar çalışmaya dahil edildi. Hastaların başvuru tanıları ve elektrolit düzeyleri kaydedildi. Elektrolit bozuklukları hafif, orta ve şiddetli olarak gruplandırıldı. Bulgular: Çalışmaya toplam 757 hasta dahil edildi. Bunların 358 (%47.3)’i kız ve 399 (%52.7)’u erkekti. Katılımcıların 649 (85.8%)’nda tekli elektrolit bozukluğu saptanırken 108 (%14.2)’nde mikst tipte elektrolit bozukluğu saptandı. Hastalarda en sık rastlanan elektrolit bozukluğu hiponatremiydi (%56). Bunu sırasıyla hiperkalemi (%27.5), hipokalemi (%19.9) ve hipernatremi (%10.8) izledi. Akut gastroenterit, hem tek hem de mikst elektrolit bozukluğu gruplarında en sık altta yatan hastalıktı. Sonuç: Çalışmamız, çocuk acil servislerinde en sık elektrolit bozukluklarının gastroenteritli hastalarda meydana geldiğini saptamıştır. Bu bozukluklar genellikle hafif şiddetteydi. Hafif elektrolit bozuklukları subklinik olabilir, bu nedenle pediatrik acil serviste rutin elektrolit ölçümü erken tanı için önemlidir.

Anahtar Kelimeler:

elektrolit bozuklukları, Çocuk acil, potasyum, sodyum

Sodium and Potassium Imbalances in the Pediatric Emergency Department: Single-Center Experience

Objective: In this study, it was aimed to examine the spectrum of sodium and potassium disorders in a pediatric emergency department. Material and Methods: Our study was cross-sectional and single-center. Patients under the age of 18, who were admitted to the pediatric emergency clinic for any reason except trauma, between 2017 and 2020 and were found to have sodium and/or potassium disorders in their examinations were included in the study. The admission diagnoses and electrolyte levels of the patients were recorded. Electrolyte disturbances were grouped as mild, moderate, and severe. Results: A total of 757 patients were included in the study. Of these, 358 (47.3%) were female and 399 (52.7%) were male. Single electrolyte disturbance was detected in 649 (85.8%) of the participants, while mixed type electrolyte disturbance was detected in 108 (14.2%). The most common electrolyte disturbance in the patients was hyponatremia (56%). This was followed by hyperkalemia (27.5%), hypokalemia (19.9%) and hypernatremia (10.8%). Acute gastroenteritis was the most common underlying disease in both the single and mixed electrolyte disorder groups. Conclusion: Our study detects that the most common electrolyte disturbances in pediatric emergency services occur in patients with gastroenteritis. These disorders were often of mild severity. Mild electrolyte disturbances may be subclinical, so routine electrolyte measurement in the pediatric emergency room is important for early diagnosis.

Keywords:

electrolyte imbalance, pediatric emergency, potassium, sodium,

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Dhondup T, Qian Q. Acid-base and electrolyte disorders in patients with and without chronic kidney disease: an update. Kidney Dis 2017;3:136-48.
Liamis G, Rodenburg EM, Hofman A, Zietse R, Stricker BH, Hoorn EJ. Electrolyte disorders in community subjects: prevalence and risk factors. Am J Med 2013;126:256-63.
Feld LG, Neuspiel DR, Foster BA, Leu MG, Garber MD, Austin K, et al. Clinical Practice Guideline: Maintenance Intravenous Fluids in Children. Pediatrics 2018;142: e20183083.
Agarwal N, Rao YK, Saxena R, Acharya R. Profile of serum electrolytes in critically ill children: A prospective study. Indian J Child Health 2018;5:128-32.
Zieg J. Pathophysiology of Hyponatremia in Children. Front J 2017;5:213.
Ali SH, Mohammed MM, Youssef RS. The Pattern of Electrolyte Imbalance in Critically Ill Children admitted in Pediatric Emergency Unit at Sohag University Hospital. The Egyptian Journal of Hospital Medicine 2021;82:276-81.
Marti G, Schwarz C, Leichtle AB, Fiedler G-M, Arampatzis S, Exadaktylos AK, et al. Etiology and symptoms of severe hypokalemia in emergency department patients. Eur J Emerg Med 2014;21:46-51.
Ravioli S, Gygli R, Funk G-C, Exadaktylos A, Lindner G. Prevalence and impact on outcome of sodium and potassium disorders in patients with community-acquired pneumonia: A retrospective analysis. Eur J Intern Med 2021;85:63-7.
Misra UK, Kalita J, Consortium TMIR. Mechanism, spectrum, consequences and management of hyponatremia in tuberculous meningitis. Wellcome Open Res 2019;4:189.
Anigilaje EA. Management of diarrhoeal dehydration in childhood: A review for clinicians in developing countries. Front Pediatr 2018;6:28.
McNab S KJ, Duke T, McCallum Z, Meehan M, Rogers. Paediatric Handbook. 9th ed. Gwee A RR, Marks M, editor: Wiley & Sons Blackwell 2015.
Daly K, Farrington E. Hypokalemia and hyperkalemia in infants and children: pathophysiology and treatment. J Pediatr Health Care 2013;27:486-96.
Rothrock SG, Green SM, McArthur C, DelDuca K. Detection of electrolyte abnormalities in children presenting to the emergency department: a multicenter, prospective analysis. Detection of Electrolyte
Abnormalities in Children Observational National Study (DEACONS) Investigators. Acad Emerg Med 1997;4:1025-31.
Elala G, Shimelis D. Patterns of electrolyte abnormalities in children 0-15 years of age admitted to pediatric Emergency and Intensive Care Units of a Tertiary Hospital. IOSR-JDMS 2018;17:12-6.
Naseem F, Saleem A, Mahar IA, Arif F. Electrolyte imbalance in critically ill paediatric patients. Pak J Med Sci 2019;35:1093-8.
Gangaraj S, Das G, Madhulata S. Electrolytes and blood sugar changes in severely acute malnourished children and its association with diarrhoea and vomiting. Int J Pharm Sci Invent 2013;2:33-6.
Bhat AW, Bhat BW. Prevalence of Patient Load with Electrolyte Abnormalities Presenting To Emergency Department at a Tertiary Care Hospital. Int J Health Sci Res 2020; 10:19-23.
Haider M, Hameed A, Fatima S, Afroze M, Noor N, Arshad U. Frequency of Electrolyte Disorders and Its Effect On Mortality Among Children Admitted In Pediatric Intensive Care Unit. JBUMDC 2020;10:115-9.