BMJ  2007;335:1109 (1 December), doi:10.1136/bmj.39409.367234.BE

Letters

Acute bronchiolitis

Risk of hyponatraemia

The first 150 words of the full text of this article appear below.

Bush and Thomson stated that electrolytes should be determined only in infants with bronchiolitis who are dehydrated.¹ This statement does not consider hyponatraemia associated with bronchiolitis, which is common in severe forms of acute bronchiolitis—it is seen in up to 33% of children in hospital with this disease.² Hyponatraemia in bronchiolitis is unrelated to dehydration and has been associated with administration of intravenous fluids together with increased antidiuretic hormone values.³ Intravenous fluids are given to children in hospital with acute bronchiolitis to manage severe respiratory distress, particularly infants who need continuous positive airways pressure.⁴

Hyponatraemia in bronchiolitis can cause generalised tonic-clonic seizures,² which may be refractory to anticonvulsants. In response to cases of fatal hyponatraemia,⁵ the National Patient Safety Agency recently issued an alert aimed at reducing the risk of hyponatraemia in children; it recommended that electrolytes should be determined before starting intravenous fluid therapy and at least daily afterwards.

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Luton and Dunstable Hospital NHS Foundation Trust, Luton LU4 ODZ

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Relevant Article

Acute bronchiolitis

Andrew Bush and Anne H Thomson
BMJ 2007 335: 1037-1041. [Extract] [Full Text] [PDF]