Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Pediatric Hyponatremia Medication

  • Author: Muthukumar Vellaichamy, MD, FAAP; Chief Editor: Timothy E Corden, MD  more...
 
Updated: Apr 26, 2014
 

Medication Summary

Medical therapy in hyponatremia includes the administration of 3% Na chloride (Na, 513 mEq/L), normal Na chloride solution (Na, 154 mEq/L), diuretics, and other drugs used to treat syndrome of inappropriate antidiuretic hormone secretion (SIADH), such as lithium carbonate, demeclocycline, ethanol, phenytoin, and vasopressin analogs.[7]

Next

Diuretics

Class Summary

These agents promote renal excretion of water and electrolytes. They are used to treat heart failure or hepatic, renal, or pulmonary disease when Na and water retention results in edema or ascites.

Furosemide (Lasix)

 

Potent loop diuretic. Inhibits reabsorption of sodium and chloride in proximal and distal tubules and loop of Henle. High efficacy largely due to unique site of action. Action on distal tubule independent of any possible inhibitory effect on carbonic anhydrase or aldosterone.

Previous
Next

ADH inhibitors

Class Summary

These agents produce diuresis by inhibiting antidiuretic hormone (ADH)-induced water reabsorption. Rarely used to treat pediatric hyponatremia in the pediatric ICU setting.

Lithium (Eskalith, Lithobid)

 

Inhibits renal response to ADH.

Demeclocycline (Declomycin)

 

Only tetracycline used to treat SIADH. Produces diuresis by inhibiting ADH-induced water reabsorption in distal portion of convoluted tubules and collecting ducts of kidneys. Effects observed within 5 d and are reversed 2-6 d after cessation of therapy. Administer 1 h before or 2-3 h after ingestion of milk or food.

Phenytoin (Dilantin)

 

Inhibits secretion of ADH.

Previous
 
 
Contributor Information and Disclosures
Author

Muthukumar Vellaichamy, MD, FAAP Clinical Assistant Professor, Department of Pediatrics, Wesley Medical Center, University of Kansas School of Medicine-Wichita

Muthukumar Vellaichamy, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Barry J Evans, MD Assistant Professor of Pediatrics, Temple University Medical School; Director of Pediatric Critical Care and Pulmonology, Associate Chair for Pediatric Education, Temple University Children's Medical Center

Barry J Evans, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Chief Editor

Timothy E Corden, MD Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, Wisconsin Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

G Patricia Cantwell, MD, FCCM Professor of Clinical Pediatrics, Chief, Division of Pediatric Critical Care Medicine, University of Miami Leonard M Miller School of Medicine/ Holtz Children's Hospital, Jackson Memorial Medical Center; Medical Director, Palliative Care Team, Holtz Children's Hospital; Medical Manager, FEMA, South Florida Urban Search and Rescue, Task Force 2

G Patricia Cantwell, MD, FCCM is a member of the following medical societies: American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Heart Association, American Trauma Society, National Association of EMS Physicians, Society of Critical Care Medicine, Wilderness Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

The author would like to acknowledge his partner at work, mentor, and great physician Lindall Smith, MD, for reading the manuscript and offering valuable advice.

References
  1. Moritz ML, Ayus JC. The pathophysiology and treatment of hyponatraemic encephalopathy: an update. Nephrol Dial Transplant. 2003 Dec. 18(12):2486-91. [Medline].

  2. Ayus JC, Achinger SG, Arieff A. Brain cell volume regulation in hyponatremia: role of sex, age, vasopressin, and hypoxia. Am J Physiol Renal Physiol. 2008 Sep. 295(3):F619-24. [Medline].

  3. Davalos MC, Barrett R, Seshadri S, Walters HL 3rd, Delius RE, Zidan M, et al. Hyponatremia during arginine vasopressin therapy in children following cardiac surgery. Pediatr Crit Care Med. 2013 Mar. 14(3):290-7. [Medline].

  4. Prasad SV, Singhi S, Chugh KS. Hyponatremia in sick children seeking pediatric emergency care. Indian Pediatr. 1994 Mar. 31(3):287-94. [Medline].

  5. Au AK, Ray PE, McBryde KD, Newman KD, Weinstein SL, Bell MJ. Incidence of postoperative hyponatremia and complications in critically-ill children treated with hypotonic and normotonic solutions. J Pediatr. 2008 Jan. 152(1):33-8. [Medline].

  6. Mentes JC. Hydration management protocol. J Gerontol Nurs. 2000 Oct. 26(10):6-15. [Medline].

  7. Sahu R, Balaguru D, Thapar V, Haque I, Pham-Peyton C, Bricker JT. Conivaptan therapy in an infant with severe hyponatremia and congestive heart failure. Tex Heart Inst J. 2012. 39(5):724-6. [Medline]. [Full Text].

  8. Rey C, Los-Arcos M, Hernández A, Sánchez A, Díaz JJ, López-Herce J. Hypotonic versus isotonic maintenance fluids in critically ill children: a multicenter prospective randomized study. Acta Paediatr. 2011 Aug. 100(8):1138-43. [Medline].

  9. Wright DG, Laureno R, Victor M. Pontine and extrapontine myelinolysis. Brain. 1979 Jun. 102(2):361-85. [Medline].

  10. Sterns RH, Cappuccio JD, Silver SM, Cohen EP. Neurologic sequelae after treatment of severe hyponatremia: a multicenter perspective. J Am Soc Nephrol. 1994 Feb. 4(8):1522-30. [Medline].

  11. Carey RG, Bucuvalas JC, Balistreri WF, Nick TG, Ryckman FR, Yazigi N. Hyponatremia increases mortality in pediatric patients listed for liver transplantation. Pediatr Transplant. 2009 Feb 20. [Medline].

  12. Adrogue HJ, Madias NE. Hyponatremia. N Engl J Med. 2000 May 25. 342(21):1581-9. [Medline].

  13. Anderson RJ. Hospital-associated hyponatremia. Kidney Int. 1986 Jun. 29(6):1237-47. [Medline].

  14. Ayus JC, Arieff AI. Pulmonary complications of hyponatremic encephalopathy. Noncardiogenic pulmonary edema and hypercapnic respiratory failure. Chest. 1995 Feb. 107(2):517-21. [Medline].

  15. Ayus JC, Armstrong D, Arieff AI. Hyponatremia with hypoxia: effects on brain adaptation, perfusion, and histology in rodents. Kidney Int. 2006 Apr. 69(8):1319-25. [Medline].

  16. Berry PL, Belsha CW. Hyponatremia. Pediatr Clin North Am. 1990 Apr. 37(2):351-63. [Medline].

  17. Brown WD. Osmotic demyelination disorders: central pontine and extrapontine myelinolysis. Curr Opin Neurol. 2000 Dec. 13(6):691-7. [Medline].

  18. Ellison DH, Berl T. Clinical practice. The syndrome of inappropriate antidiuresis. N Engl J Med. 2007 May 17. 356(20):2064-72. [Medline].

  19. Fraser CL, Arieff AI. Epidemiology, pathophysiology, and management of hyponatremic encephalopathy. Am J Med. 1997 Jan. 102(1):67-77. [Medline].

  20. Gross P. Treatment of severe hyponatremia. Kidney Int. 2001 Dec. 60(6):2417-27. [Medline].

  21. Gruskin AB, Sarnaik A. Hyponatremia: pathophysiology and treatment, a pediatric perspective. Pediatr Nephrol. 1992 May. 6(3):280-6. [Medline].

  22. Hackethal V. Hypotonic IV Fluid May Raise Hyponatremia Risk in Children. Medscape Medical News. Dec 31 2013. Available at http://www.medscape.com/viewarticle/818498. Accessed: January 14, 2014.

  23. Harrigan MR. Cerebral salt wasting syndrome. Crit Care Clin. 2001 Jan. 17(1):125-38. [Medline].

  24. Haycock GB. The syndrome of inappropriate secretion of antidiuretic hormone. Pediatr Nephrol. 1995 Jun. 9(3):375-81. [Medline].

  25. Kappy MS, Ganong CA. Cerebral salt wasting in children: the role of atrial natriuretic hormone. Adv Pediatr. 1996. 43:271-308. [Medline].

  26. Kennedy PG, Mitchell DM, Hoffbrand BI. Severe hyponatraemia in hospital inpatients. Br Med J. 1978 Nov 4. 2(6147):1251-3. [Medline]. [Full Text].

  27. Lin M, Liu SJ, Lim IT. Disorders of water imbalance. Emerg Med Clin North Am. 2005 Aug. 23(3):749-70, ix. [Medline].

  28. Marino PL. Hypertonic and hypotonic syndromes. The ICU Book. 2nd ed. Philadelphia, Pa: Lippincott Williams and Wilkins; 1998. 631-46.

  29. Martin RJ. Central pontine and extrapontine myelinolysis: the osmotic demyelination syndromes. J Neurol Neurosurg Psychiatry. 2004 Sep. 75 Suppl 3:iii22-8. [Medline].

  30. Moritz ML, Ayus JC. Disorders of water metabolism in children: hyponatremia and hypernatremia. Pediatr Rev. 2002 Nov. 23(11):371-80. [Medline].

  31. Musana AK, Yale SH. Central pontine myelinolysis: case series and review. WMJ. 2005 Aug. 104(6):56-60. [Medline].

  32. Oh MS, Kim HJ, Carroll HJ. Recommendations for treatment of symptomatic hyponatremia. Nephron. 1995. 70(2):143-50. [Medline].

  33. Sterns RH. The treatment of hyponatremia: first, do no harm. Am J Med. 1990 Jun. 88(6):557-60. [Medline].

  34. Sterns RH, Silver SM. Brain volume regulation in response to hypo-osmolality and its correction. Am J Med. 2006 Jul. 119(7 Suppl 1):S12-6. [Medline].

  35. Verbalis JG, Goldsmith SR, Greenberg A, Schrier RW, Sterns RH. Hyponatremia treatment guidelines 2007: expert panel recommendations. Am J Med. 2007 Nov. 120(11 Suppl 1):S1-21. [Medline].

  36. Wang J, Xu E, Xiao Y. Isotonic Versus Hypotonic Maintenance IV Fluids in Hospitalized Children: A Meta-Analysis. Pediatrics. 2014 Jan. 133(1):105-13. [Medline].

  37. Yeates KE, Singer M, Morton AR. Salt and water: a simple approach to hyponatremia. CMAJ. 2004 Feb 3. 170(3):365-9. [Medline].

  38. Zarinetchi F, Berl T. Evaluation and management of severe hyponatremia. Adv Intern Med. 1996. 41:251-83. [Medline].

 
Previous
Next
 
Drugs that impair water excretion.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.