Association between moderate–severe bronchiolitis and syndrome of inappropriate antidiuretic hormone secretion in emergency departments
| Autor: | M.C. Miguez Navarro, E. González Ruiz de León, B. Toledo del Castillo, A. Rivas García, P. Vázquez López, R. Marañón Pardillo |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Secreción inadecuada de hormona antidiurética
medicine.medical_specialty medicine.drug_class medicine.medical_treatment Urine Pediatrics RJ1-570 03 medical and health sciences 0302 clinical medicine 030225 pediatrics Management of Technology and Innovation Internal medicine Bronchodilator medicine 030212 general & internal medicine Intensive care medicine Prospective cohort study Niños Mechanical ventilation business.industry Bronquiolitis medicine.disease Pneumonia Bronchiolitis Syndrome of inappropriate antidiuretic hormone secretion Urine osmolality Virus respiratorio sincitial business |
| Zdroj: | Anales de Pediatría (English Edition), Vol 84, Iss 1, Pp 24-29 (2016) |
| ISSN: | 2341-2879 |
| Popis: | Objectives: To identify clinical characteristics that may lead to the early identification of patients hospitalised for moderate-to-severe bronchiolitis with urine results associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Patients and methods: A prospective observational study was conducted, spanning the bronchiolitis epidemic season (October 2012–March 2013), including all children who were hospitalised with a diagnosis of moderate-to-severe bronchiolitis. The following criteria were used to establish a diagnosis of SIADH: urine sodium level of 40 mmol/L or greater, urine osmolarity above 500 mosm/kg, and urine density of 1020 g/L or greater. Demographic characteristics, ventilation mode and clinical outcome were also analysed. A comparison was made between patients that met urine SIADH criteria and those that did not. Results: A total of 126 children were included, 23 (18.6%) with urine SIADH criteria. Patients in this group had a higher incidence of pneumonia and/or atelectasis on chest X-ray (21.7% vs. 1.9%, p = .002), worse response to bronchodilator treatment with nebulised adrenaline (69.5% vs. 28,1%, p = .016), more need for respiratory assistance (high flow oxygen therapy (17.4% vs. 7.7%, p = .016)), or non-invasive mechanical ventilation (13% vs. 5.8%, p = .034), and more admissions to the PICU (26.1% vs. 6.8%, p = .007). Conclusions: Patients older than 1 month with acute moderate bronchiolitis and urine SIADH criteria present poorer progress and greater need for non-invasive mechanical ventilation, PICU admission, and a higher incidence of pneumonia on chest X-ray. For this reason, urine samples should be collected from these patients for early diagnosis of SIADH, and thus early treatment of fluid and electrolyte abnormalities. Resumen: Objetivos: Identificar precozmente y analizar las características de pacientes que precisan ingreso por bronquiolitis moderada o grave que cumplen criterios urinarios de SIADH. Pacientes y métodos: Estudio prospectivo observacional, realizado entre octubre de 2012-marzo de 2013 en urgencias pediátricas. Se incluyen menores de 12 meses con bronquiolitis moderada o grave que requieren ingreso. Se consideran criterios urinarios de SIADH: sodio urinario ≥ 40 mmol/l, osmolaridad urinaria > 500 mOsm/kg y densidad urinaria > 1.020 g/l. Se recogen variables epidemiológicas y clínicas y se comparan 2 grupos definidos por cumplir o no criterios urinarios de SIADH. Resultados: Se incluyen 126 pacientes con bronquiolitis moderada, 23 (18,6%) cumplen criterios urinarios de SIADH, ninguno grave ni menor de un mes. Los pacientes con criterios urinarios de SIADH tienen mayor incidencia de neumonía y/o atelectasia en la radiografía de tórax (21,7% vs. 1,9%; p = 0,002), peor respuesta al tratamiento con adrenalina (69,5% vs. 28,1%; p = 0,016), mayor asistencia respiratoria: oxigenoterapia de alto flujo (17,4% vs. 7,7%; p = 0,016) y ventilación mecánica no invasiva (13% vs. 5,8%; p = 0,034). Requieren más días oxigenoterapia (p = 0,02) y tratamiento broncodilatador (p = 0,04) y mayor ingreso en cuidados intensivos pediátricos (26,1% vs. 6,8%; p = 0,007). Conclusiones: Los pacientes mayores de 1 mes con bronquiolitis moderada y con criterios urinarios de SIADH tienen peor evolución respiratoria, mayor necesidad de soporte respiratorio, ingreso en UCIP y más alteraciones radiográficas. Por ello recomendamos realizar determinaciones de orina a estos pacientes para detectar precozmente el desarrollo de SIADH y cuidar el manejo hidroelectrolítico, previniendo el desarrollo de complicaciones potencialmente graves. |
| Databáze: | OpenAIRE |
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