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22-08-2011 | Article

Hypernatremia specific complication of rotavirus gastroenteritis

Abstract

Free abstract

MedWire News: Young children hospitalized with acute gastroenteritis (AGE) caused by rotavirus (RV) infection are specifically at risk for hypernatremia, study results suggest.

"Given the availability of two safe and efficacious RV vaccines, these findings provide new insights into the specific and serious, life-threatening morbidity of RV infection and also highlight the need for national vaccination programs," say Hans-Iko Huppertz (Bremen Hospital, Germany) and co-authors.

They add: "According to our data, prevention of RV infection could prevent more than 75% of cases of hypernatremia in young children."

The findings arise from a retrospective analysis of data collected from German children aged less than 5 years and hospitalized with AGE between October 2002 and May 2008. Over this time period, 6884 patients were admitted to hospital with AGE and 4880 had stool testing for the presence of RV.

In all, 2118 (43.3%) stool-tested AGE patients tested positive for RV, and 1005 of these (47.5%) had acute complications or concomitant symptoms, including sepsis, urinary tract infection, and dehydration. A total of 61.8% of RV-negative children also had these complications.

Respective 64 and 19 cases of hypernatremia and severe hypernatremia occurred among the groups, with both conditions defined as serum sodium levels greater than 150 and 159 mmol/l, respectively.

As reported in the European Journal of Pediatrics, 76.6% and 78.9% of hypernatremia and severe hypernatremia cases were due to RV infection. Specifically, mean serum sodium was 0.59 mmol/l higher in RV-positive than RV-negative AGE patients.

Furthermore, compared with its absence, the presence of hypernatremia, severe or otherwise, was associated with severe AGE, longer hospitalization periods, and a requirement for intensive care.

Indeed, 18.4% versus 1.4% of hypernatremic and non-hypernatremic RV-positive patients needed intensive care treatment. The mean hospitalization duration was 7.4 versus 5.3 days among the respective groups.

"Hypernatremia often indicates severe disease, severe dehydration, and was called 'infant toxicosis' or 'hyperpyretic toxicosis' in the old pediatric literature," say Huppertz and team.

They conclude: "Our findings suggest that RV is by far the most frequent cause of infant toxicosis. Since treatment of hypernatremia is an emergency and sometimes cumbersome, every effort should be made to avoid it."

By Lauretta Ihonor