Hypernatremia in children with diarrhoea at a tertiary institution in Harare

Abstract

Objectives: To determine the prevalence of hypernatremia (serum sodium>150mmol/l), associated factors and outcome of children below 2yrs of age admitted with diarrhoea.

Design: Cross sectional analytical study.

Setting: Harare Children's Hospital, Harare, Zimbabwe.

Subjects: Consecutive sampling was used to recruit 127 children between the ages of 1 month and 2 years admitted into the hospital with diarrhoea.

Materials and Methods: An interviewer administered questionnaire was used to capture data from the caregivers and each of the participants had anthropometric measurements noted and urea and electrolytes analysed. A univariate logistic regression was performed at 5% significance level to identify factors associated with hypernatremia and odds ratios were calculated. A multivariate logistic regression analysis was then performed on factors with p<0.25.

Main Outcome Measures: Hypernatremia, hydration and nutrition.

Results: The prevalence of hypernatremia was 27.6% (95% CI 19.68-35.44). Those likely to have hypernatremia were younger than 6months (OR 4.77 95% CI 2.08-10.9), had ≥5 stools per day (OR 3.21 95% CI 1.43-7.19 ) , no co-morbidity (OR 3.1 95% CI 1.27-7.52) , fever ( OR 2.43 95% CI 1.01-5.88 ), normal height for age (OR 7.37 95% CI 1.65-32.95 ) , some dehydration (OR 15.7 95% CI 1.99-123.8 ) and severe dehydration (OR 24.6 95% CI 2.97-203.8). The only strong determinant of hypernatremia after multivariate analysis was age <6months (OR 4.76 95% CI 1.08-20).The overall mortality was 13.4% and hypernatremia was significantly associated with mortality (p= 0.001)

Conclusion: The prevalence of hypernatremia among children with diarrhoea was high. Children less than 6 months of age were most likely to have hypernatremia. The mortality was high among the children with hypernatremic dehydration.