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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 December 1; 335(7630): 1109.
PMCID: PMC2099548
Acute Bronchiolitis

Risk of hyponatraemia

Michael Eisenhut, consultant paediatrician

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.


Bush A, Thomson AH. Acute bronchiolitis. BMJ 2007;335:1037-41. (17 November.) [PMC free article] [PubMed]
Hanna S, Tibby SM, Durward A, Murdoch IA. Incidence of hyponatraemia and hyponatraemic seizures in severe respiratory syncytial virus bronchiolitis. Acta Paediatr 2003;92:430-4. [PubMed]
Eisenhut M. Extrapulmonary manifestations of severe respiratory syncytial virus infection—a systematic review. Crit Care 2006;10:R107. [PMC free article] [PubMed]
Thia LP, McKenzie SA, Blyth TP, Minasian CC, Kozlowska WJ, Carr SB. Randomised controlled trial of nasal continuous positive airways pressure (CPAP) in bronchiolitis. Arch Dis Child 2007 Mar 7 online publication ahead of print.
National Patient Safety Agency. Patient safety alert 22. Reducing the risk of hyponatraemia when administering intravenous infusions to children. 2007.

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