Pediatric Hyponatremia Clinical Presentation

Updated: Dec 21, 2020
  • Author: Muthukumar Vellaichamy, MD, FAAP; Chief Editor: Timothy E Corden, MD  more...
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The history of patients with hyponatremia may include the following:

  • Hypotonic fluid use for maintenance hydration in hospitalized children (potential risk factor)

  • Feeding with hypotonic formula or excessive free water during infancy

  • Conditions that cause gastrointestinal (GI), Na-rich fluid loss, including diarrhea, vomiting, or fistulas

  • Renal disorders, including salt-losing nephropathy, acute renal failure, or chronic renal failure

  • Postoperative states [12]

  • Psychiatric conditions

  • Coma

  • Drug use

  • Central nervous system (CNS) and pulmonary diseases

  • Cirrhosis

  • Congestive heart failure

  • Acquired immunodeficiency syndrome (AIDS)


Physical Examination

Central nervous system (CNS) findings

Early CNS signs include the following:

  • Anorexia

  • Headache

  • Nausea

  • Emesis

Advanced CNS signs include the following:

  • Impaired response to verbal stimuli

  • Impaired response to painful stimuli

  • Bizarre behavior

  • Hallucinations

  • Obtundation

  • Incontinence

  • Respiratory insufficiency

  • Seizure activity

Far-advanced CNS signs include the following:

  • Decorticate or decerebrate posturing

  • Bradycardia

  • Hypertension or hypotension

  • Altered temperature regulation

  • Dilated pupils

  • Seizure activity

  • Respiratory arrest

  • Coma

Cardiovascular findings

Cardiovascular findings may include the following:

  • Hypotension

  • Tachycardia

Musculoskeletal findings

Musculoskeletal findings may include the following:

  • Weakness

  • Muscular cramps