Effect Of Maintenance Solution With Different Tensions On Serum Sodium In Hospitalized Children At Different Copeptin Levels

BackgroundHyponatremia is the most common electrolyte disorder in hospitalized children,which can aggravate primary diseases,prolong hospital stay,and increase mortality.Previous studies have shown that hyponatremia in hospitalized children is mostly the result of the combined effect of over secretion of antidiuretic hormone(ADH)and intake of free water.However,ADH is difficult to detect in the blood and has a short half-life.As a biotin homologous with ADH,copeptin is secreted in roughly the same amount as ADH,which is relatively stable in serum and easy to detect.Objective1)To study the incidence of hyponatremia in hospitalized children after treatment with maintenance solution and the influence factors on the occurrence of hyponatremia;2)To explore the secretion levels of copeptin in children with different disease states;3)To explore the effect of maintenance solution on hyponatremia in children at different copeptin levels.MethodsChildren(aged 29 days to 14 years)who were hospitalized in the General Hospital of Southern Theater Command from January 2021 to January 2023 and required at least 24 hours of treatment with more than half of the physiological requirement of intravenous maintenance solution were included.Baseline data(age,gender,body weight,primary diagnosis),clinical indicators(fluid supplement,sodium supplement,food intake,urine volume,body weight change,hyponatremia-related symptoms,edema,non-cardiogenic pulmonary edema),and test indicators(serum copeptin,blood electrolytes,renal function,etc.)were collected.ResultsA total of 111 children were enrolled,including 40 cases of central nervous system disease,14 cases of respiratory disease,25 cases of gastrointestinal disease,20 cases of hematological tumor diseases,12 cases of sepsis or systemic inflammatory response syndrome.This study found that hyponatremia occurred in 27.9%(31/111),including mild hyponatremia in 23.4%(26/111)and moderate hyponatremia in 4.5%(5/111).For hospitalized children who require maintenance fluid treatment,there were statistically significant different in the incidence of hyponatremia after 24 hours treatment among children with different levels of copeptin,different levels of maintenance solution tension,whether in severely or critically ill state,and whether underwent surgical treatment(all P<0.05).Multivariate logistic regression analysis showed that higher level of copeptin,severity or critical ill state were risk factors for the occurrence of hyponatremia,while higher total fluid tension was the protective factor for the occurrence of hyponatremia(all P<0.05).Copeptin levels in the study subjects were higher than those in the health population,and copeptin secretion levels were different in different disease states(P<0.001).The contingency table analysis showed that the incidence of hyponatremia was lower in children with low level of copeptin or treated with higher level of maintenance solution tension(≥1/2 tension),which were 1.8%(1/56)and 6.3%(2/32),respectively.Conclusions1)The incidence of hyponatremia was high in hospitalized children who need more than 24 hours of maintenance solution infusion,and elevated levels of copeptin and low tension solution infusion were associated with the occurrence of hyponatremia;2)There are significant differences in the copeptin level in children with different disease states;3)At different levels of copeptin,maintenance solution has different effects on hyponatremia in children;4)Hospitalized children requiring more than 24 hours of maintenance fluid infusion,relatively higher tension maintenance fluid(total liquid tension ≥1/2 tension)was recommended.