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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.
Fluids should be restricted in children with hyponatraemia who are receiving intravenous 0.9% saline (with 5% dextrose) and who have high antidiuretic hormone values.
Competing interests: None declared.