Dysnatremia and Subsequent Serum Sodium Level Changes Following Various Intravenous Treatments in Infants with Acute Gastroenteritis

Abstract

Abstract Purpose Acute gastroenteritis (AGE) is one of the main causes of electrolyte imbalance in infants. We aimed to determine the incidence of and factors associated with early dysnatremia and establish the ideal intravenous (IV) treatment scheme. Methods The records of hospitalized infants aged 1–12 months with community-acquired AGE between January 2017 and March 2021 were retrospectively reviewed. Factors associated with early dysnatremia were analyzed by multivariable logistic regression analysis. Subsequent serum sodium levels 4–24 hours after IV fluid treatments, which were categorized into 3 groups, were determined in the subgroup of infants with early isonatremia. Results In total, 347 infants with a median age of 8.0 (5.0, 10.0) months were included. The incidence of early dysnatremia was 14.4% (hyponatremia 12.4% and hypernatremia 2.0%). Severe dehydration was associated with early dysnatremia (p = 0.048). Among 70 infants with early isonatremia, the median serum sodium change was highest in the D-5NS group, with changes of + 3 (0.5, 5), + 1 (-2, 2) and − 2.5 (-4, 2.3) mmol/L in infants who received D5-NS, D-1/2NS, and D5-1/3 − 1/5NS, respectively (p = 0.003). Four out of 39 infants (10.3%) developed hyponatremia while receiving D5-1/2NS. None of those who received D5-NS developed subsequent dysnatremia. Conclusions The incidence of early dysnatremia among infants with AGE was 14.4%. Severe dehydration was a strong factor associated with early dysnatremia, so electrolyte levels need to be assessed. The use of isotonic solution did not promote acquired dysnatremia. We therefore recommend that isotonic solution be considered for infants with AGE.