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      Sodium assessment in neonates, infants, and children: a systematic review

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          Abstract

          Hyponatremia is a common disorder in childhood. The indirect and the direct potentiometry are currently the most popular techniques employed for sodium assessment, although discrepancies between the two techniques may be > 10 mmol/L. It is known that < 20% of the recently published articles report information about the technique used for sodium analysis, but no data are available on pediatric studies. This study aimed at investigating the laboratory technique employed for sodium measurement in studies conducted in childhood. A systematic literature search in PubMed, Embase, and Web of Science was undertaken to identify articles containing the word “hyponatremia” in the title between 2013 and 2020. Papers with < 10 subjects were excluded. A total of 565 articles were included. Information on the laboratory technique used for sodium analysis was more commonly ( p = 0.035) reported in pediatric ( n = 15, 28%) than in non-pediatric ( n = 81, 16%) reports. The frequency of reports with and without information on the technique for sodium assessment was not different with respect to the study characteristics, the quartile of the journal where the paper was published, the country income setting, and the inclusion of neonates among the 54 pediatric studies.

             Conclusion: Most pediatric papers do not report any information on the technique used for sodium analysis. Although international authorities have recommended the implementation of direct potentiometry, a low awareness on this issue is still widespread in pediatric research.

          What is Known:
          •  Direct potentiometry and indirect potentiometry are currently employed for sodium analysis in blood.
          •  Direct potentiometry is more accurate.
          What is New:
          Less than 30% of pediatric articles provide information on the technique employed for sodium analysis in blood.
          Indirect potentiometry is more frequently employed than direct potentiometry in pediatric studies.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s00431-022-04543-3.

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          Most cited references24

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          Clinical practice guideline on diagnosis and treatment of hyponatraemia.

          Hyponatraemia, defined as a serum sodium concentration <135 mmol/L, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. Hyponatraemia is present in 15-20% of emergency admissions to hospital and occurs in up to 20% of critically ill patients. Symptomatology may vary from subtle to severe or even life threatening. Despite this, the management of patients remains problematic. Against this background, the European Society of Intensive Care Medicine, the European Society of Endocrinology and the European Renal Association-European Dialysis and Transplant Association, represented by European Renal Best Practice have developed a Clinical Practice Guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia.
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            Prevention of hospital-acquired hyponatremia: a case for using isotonic saline.

            The current standard of care in pediatrics is to administer hypotonic saline in maintenance parenteral fluids. The safety of this approach has never been evaluated. A review of the literature reveals that the administration of hypotonic fluids is potentially dangerous and may not be physiologic for the hospitalized child. There have been >50 reported cases of neurologic morbidity and mortality, including 26 deaths, in the past 10 years resulting from hospital-acquired hyponatremia in children who were receiving hypotonic parenteral fluids. Common childhood conditions requiring parenteral fluids, such as pulmonary and central nervous system infections, dehydration, and the postoperative state, are associated with a nonosmotic stimulus for antidiuretic hormone production, which can lead to free water retention and hyponatremia. Children are at particularly high risk of developing symptomatic hyponatremia as they have a larger brain-to-skull size ratio. The administration of isotonic saline in maintenance parenteral fluids is the most important prophylactic measure that can be taken to prevent the development of hyponatremia in children who receive parenteral fluids.
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              • Record: found
              • Abstract: not found
              • Article: not found

              Maintenance Intravenous Fluids in Acutely Ill Patients.

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                Author and article information

                Contributors
                antonio.corsello@unimi.it
                sabrina.muller@bluewin.ch
                Mario.bianchetti@usi.ch
                carlo.agostoni@unimi.it
                barbara.cantoni@policlinico.mi.it
                Francesco.Meani@eoc.ch
                pietroBenedetto.Fare@eoc.ch
                milani.gregoriop@gmail.com
                Journal
                Eur J Pediatr
                Eur J Pediatr
                European Journal of Pediatrics
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0340-6199
                1432-1076
                12 July 2022
                12 July 2022
                2022
                : 181
                : 9
                : 3413-3419
                Affiliations
                [1 ]GRID grid.4708.b, ISNI 0000 0004 1757 2822, Department of Clinical Sciences and Community Health, , Università Degli Studi Di Milano, ; Milan, Italy
                [2 ]GRID grid.29078.34, ISNI 0000 0001 2203 2861, Faculty of Biomedical Sciences, , Università Della Svizzera Italiana, ; Lugano, Switzerland
                [3 ]GRID grid.414818.0, ISNI 0000 0004 1757 8749, Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, ; Milan, Italy
                [4 ]GRID grid.469433.f, ISNI 0000 0004 0514 7845, Department of Gynecology and Obstetrics, Centro Di Senologia Della Svizzera Italiana, , Ente Ospedaliero Cantonale, ; Lugano, Switzerland
                [5 ]GRID grid.469433.f, ISNI 0000 0004 0514 7845, Department of Internal Medicine, , Ente Ospedaliero Cantonale, ; 6600 Locarno, Switzerland
                Author notes

                Communicated by Daniele De Luca

                Author information
                http://orcid.org/0000-0003-3829-4254
                Article
                4543
                10.1007/s00431-022-04543-3
                9395449
                35821131
                23180629-05e6-4c68-8c2b-75fcdd5e1c81
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 14 December 2021
                : 15 June 2022
                : 23 June 2022
                Funding
                Funded by: Italian Ministry of Helath
                Award ID: Ricerca corrente
                Award Recipient :
                Funded by: Università degli Studi di Milano
                Categories
                Original Article
                Custom metadata
                © Springer-Verlag GmbH Germany, part of Springer Nature 2022

                Pediatrics
                hyponatremia,electrolytes,pediatrics,laboratory,potentiometry
                Pediatrics
                hyponatremia, electrolytes, pediatrics, laboratory, potentiometry

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