Hyponatremia in children with acute lymphoblastic leukemia

INTRODUCTION: Hyponatremia is a common electrolyte abnormality in hospitalized patients. Administration of isotonic maintenance fluids are recommended to prevent hyponatremia. The present study was conducted to evaluate the frequency and severity of hyponatremia in children with acute lymphoblastic leukemia (ALL).
METHODS: The frequency, severity and possible causes of hyponatremia in children with ALL throughout their entire intensive treatment were retrospectively evaluated. All children in this study received isotonic fluids as maintenance iv treatment during hospitalization period.
RESULTS: In a five year period 618 hyponatremia episodes were seen in 92 children with ALL (median age 59 months), treated with ALLIC 2002 protocol were entered into the study. The median hyponatremia episode per patient was 6. All patients had at least one hyponatremia episode which of them were classified as mild in 83.2 %, moderate in 13.2 %, severe in 2.9% and very severe in 0.6%. The median duration of hyponatremia episodes was 5 (range netween 1-43) days. Total duration of all hyponatremia episodes of each patient was changed between 6 to 138 days with a median of 30 days.
In 241 episodes of 68 children there was inadequate salt intake secondary to oral feeding intolerace, nausea, vomitting and oral aftous stomatitis.
In four patients seizure was seen during hyponatremia period and thought to be secondary to hyponatremic encephalopathy. No patient developed central pontine myelinosis.
DISCUSSION AND CONCLUSION: Hyponatremia is very frequent in ALL patients. Despite use of isotonic iv fluids it seems can not be completely prevented.