University of Oulu

Lehtiranta, S., Honkila, M., Kallio, M. et al. Severe hospital-acquired hyponatremia in acutely ill children receiving moderately hypotonic fluids. Pediatr Nephrol 37, 443–448 (2022).

Severe hospital-acquired hyponatremia in acutely ill children receiving moderately hypotonic fluids

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Author: Lehtiranta, Saara1,2; Honkila, Minna1,2; Kallio, Merja2,3;
Organizations: 1Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, PO Box 23, N90029, OYS, Oulu, Finland
2PEDEGO (Pediatrics, Dermatology, Gynecology and Obstetrics) Research Unit and Medical Research Centre Oulu, University of Oulu, Oulu, Finland
3Department of Pediatric Cardiology, New Children’s Hospital, University Hospital of Helsinki, Helsinki, Finland
4Biocenter Oulu, University of Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
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Language: English
Published: Springer Nature, 2022
Publish Date: 2022-03-08


Background: Hypotonic fluids have been associated with hospital-acquired hyponatremia. The incidence of life-threatening severe hyponatremia associated with hypotonic fluids has not been evaluated.

Methods: This was a population-based cohort study of 46,518 acutely ill children 15 years of age or under who visited the pediatric emergency department (ED) at Oulu University Hospital, Finland, between 2007 and 2017. We retrieved all electrolyte measurements from the comprehensive electronic laboratory system and reviewed medical records for all patients with severe hyponatremia.

Results: The overall occurrence of severe hyponatremia (serum sodium < 125 mmol/L) was found in 27 out of 46,518 acutely ill children (0.06%, 95% confidence interval 0.04–0.08%). After admission, severe hyponatremia developed in seven of 6,984 children receiving moderately hypotonic fluid therapy (0.1%, 95% confidence interval 0.04–0.2%), usually within 8 h of admission. All children who developed severe hyponatremia during hospitalization were severely ill.

Conclusion: In this register-based cohort study of children presenting to the ED, severe hyponatremia developed in one of 998 acutely ill children receiving moderately hypotonic fluid therapy.

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Series: Pediatric nephrology
ISSN: 0931-041X
ISSN-E: 1432-198X
ISSN-L: 0931-041X
Volume: 37
Issue: 2
Pages: 443 - 448
DOI: 10.1007/s00467-021-05227-0
Type of Publication: A1 Journal article – refereed
Field of Science: 3123 Gynaecology and paediatrics
3121 General medicine, internal medicine and other clinical medicine
Funding: Open access funding provided by University of Oulu including Oulu University Hospital. The study was supported by the Alma and K A Snellman Foundation, Finland (Saara Lehtiranta); the Foundation for Pediatric Research, Finland (Saara Lehtiranta, Minna Honkila, Terhi Tapiainen); and the Academy of Finland (Terhi Tapiainen).
Copyright information: © The Author(s) 2021, corrected publication 2021. This 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