Essay Sample #1 - The Frequency of Occurrence of Hyponatremia
During the research, there was little information gathered from other previous studies that yielded similar observation except from Prasad et al. and the Indian studies. It was clear that hyponatremia can easily be described using variable frequencies in majority of children and young adults. However, in most cases, the described variable frequency differs based on the degree of hyponatremia and the difference in age among pediatric patients (Berry & Belsha 1999). In our methodology, a sample size of 162 children was taken and admitted to Pediatric Intensive Care Unit (PICU), which is observed to be less than that of Prasad et al. and Indian whose sample sizes were 727 children and 500 children respectively. By comparing the childrens Mean +SD age among the three studies, it is perceived that Indian mean +SD of 4.32+_3.935 years is greater than our estimated mean +SD of 3.29+_3.93 years and that of Prasad et al. 3.14+_3.18 years.
The results on the frequency distribution of serum sodium concentration among the sample size in our research methodology shows that it is less than the frequency distribution of serum sodium concentration in both Prasad et al. and Indian researches.
According to Prasad et al. study, the frequency of hyponatremia in summer (36%) was one and half times that of winter (24%). The study also concludes that the frequency of severe hyponatremia was 7.6% in summer and 5.4% in winter. It discusses that the frequency of hyponatremia was 26% in Pneumonia and 33% in meningoenceophalitic illness, which was higher during summers as compared to winters. The study also assumes that about 80% of cases of hyponatremia that were associated with acute respiratory illness, meningitis, and seizures were of dilution type (Prasad et al. 1994). According to the Indian study, the frequency of hyponatremia was 20.54% cases in meningitis, 12.43% in pneumonia and 7.56% in seizures. The study also explains that among children with congenital heart diseases 67% had hyponatremia (Prasad et al. 1997).
In normal cases, sodium concentration of plasma is often maintained between 135 and 145 mmol/L and in case it drops to less than 135mmol/L, a case of Hyponatremia is experienced. Hyponatremia in pediatric intensive care patients is normally subordinate to some conditions such as heart failure, renal failure and pneumonia. Some previous studies assume that hyponatremia can be seen in patients suffering from renal diseases such as nephritic syndrome. Hyponatremia is at times associated with several types of cancers such as leukemia (Chiang, Wattad & Hill 1992). This study assumes that in the category of mild hyponatremia using a sample size of 162 patients, 36% of neurological cases, 78.9% of cardiac cases, and 70.7% of patients diagnosed with respiratory diseases were discharged, and 12.2% of the patients died. Among the shock cases noted down, 36.4% were discharged and 10.5% died in the same category whereas 18.4% and 13.2% of patients were discharged in moderate and severe hyponatremia, respectively (Shann & Germer 1996). In addition, records of trauma cases showed that all of the patients were discharged with mild hyponatremia.
Additionally, the level of mortality linked to hyponatremia is frequently high. It is sometimes hard to establish the exact Hyponatremias effect to the rates of mortality as a result of the traditional other high risk co-morbid disorders coexistence. For instance, some researches assume that patients who developed seizures have a higher mortality level. Nevertheless, extreme hyponatremia in pediatric patients is frequently linked to 20-times higher mortality especially when in comparison with unselected patients of similar age range. In the availability of substantial co-morbidity disorders, it is sometimes difficult to evaluate the exact effect of hyponatremia that would result to death (Fraser, Ayus & Arieff 1992).
Essay Sample #2 - Hyponatremia in hospitalized children
Hyponatremia is one of the commonest encountered electrolyte disorders in most pediatric children. However, this disorder contributes to substantial mortality and morbidity among patients admitted to Pediatric Intensive Care Unit (PICU). The disorder can easily be described using variable frequencies in majority of children and young adults. In most cases, these described variable frequencies differ based on the level of hyponatremia and the difference in age among pediatric patients (Berry & Belsha 1999). In the process of acquiring data from previous studies, the Prasad et al. and the Indian studies produced enough information that yielded similar observation as that in our research methodology. In order to understand how our methodology differs from that of Prasad et al. and the Indian study, sample sizes of all pediatrics and variables, such as the level of sodium in pediatric patients, will be used.
From our study, a sample size of children aged from 1 month to 12 years was taken, where some of them needed immediate admission to PICU after presenting a case of hyponatremia, and others whose hyponatremia were corrected before their admission to PICU, were excluded. In comparison to the Indian study, a sample size of children from the age of 1 month to 14 years was taken during summers and winters. In addition, Prasad et al. study used a sample size of children up to 12 years during the summer irrespective of their primary diagnosis or severity of the illness.
Our study defines sodium level of 131-135 as mild hyponatremia, 125-130 as moderate hyponatremia and less than 125 as severe hyponatremia. In comparison to the Indian study, it classified its patients with sodium level of 130-135 as mild hyponatremia, 125-130 as moderate hyponatremia and less than 125 as severe hyponatremia. Additionally, Prasad et al. study, grouped patients on the basis of sodium level of less that 130 as mild hyponatremia, greater that 130 as moderate hyponatremia, and less than 125 as severe hyponatremia.
FREQUENCY OF HYPONATREMIA IN DIFFERENT OTHER DISEASES
Hyponatremia is a frequent finding in most children with pneumonia. Usually, it consist of part of the syndrome of improper secretion of anti-diuretic hormone (SIADH), which results in water preservation with slight weight gain, commonly with lack of oedema formation, and a standard blood pressure (Shann & Germer, 1996). According to research made by Prasad et al. (1994) and Prasad et al. (1997), SIADH occur in approximately one third of children admitted due to cases of pneumonia, and was related with a more severe disease and a poorer result. The lower respiratory infections, which include pneumonia, asthma, and bronchitis, still continue to threaten the health of children all over the world, mostly in developing nations, where there is poor nutrition and scarce health care access.
HYPONATREMIA AND HOSPITAL LENGTH OF STAY
In our findings, hospital-acquire hyponatemia in men (58.1%), resulted in increases in length of hospital stay that were associated with the severity of hospital-acquired hyponatremia as compared to women (41.9%). Other previous studies done assume that during hospitalization, the occurrence of hyponatremia may represent an important factor that influences the outcome and the length of hospital stay (Chiang, Wattad & Hill, 1992). Active effective and timely on the standardization of sodium levels might have a positive effect on the diagnosis of the pediatric patients setting, in addition to the length of hospital stay, thus potentially reducing patients costs in hospitals.
Chiang ML, Wattad A & Hill LL. (1992). Hyponatremia in hospitalized children. Chicago: Chicago University Press. Print
Fraser CL, Ayus JC & Arieff AI. (1992). Hyponatremia and death or permanent brain damage in healthy children. London: McGraw Hill. Print
Shann F & Germer S. (1996). Hyponatremia associated with pneumonia or bacterial meningitis. Arch Dis Child. New York: Prentice Hall. Print
Berry PL & Belsha CW. (1999). Hyponatremia. Pediatric Clinic North America. Arch Dis Child. New York: New York University Press. Print
Prasad et al. (1997). Hyponatremia in sick children seeking pediatric emergency care. Indian Pediatrics. India: University College of Medical Science and GTB Hospital
Prasad et al. (1994). Hyponatremia in sick children: A market of serious illness. Indian Pediatrics. India: University College of Medical Science and GTB Hospital
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