IMPACT OF HYPONATREMIA ON OUTCOME OF CHILDREN WITH COMMUNITY ACQUIRED PNEUMONIA By

Background: Community-acquired (CAP) and nosocomial pneumonias contribute substantially to morbidity and hospital resource utilization. Hyponatremia, occurring in >1/4 of patients with CAP, is associated with greater disease severity and worsened outcomes. Aim and objectives: The aim of this work to identify the incidence of hyponatremia in children with community acquired pneumonia and to study the impact of hyponatremia regarding the severity of symptoms, duration of hospitalization and outcome of community acquired pneumonia. Subjects and methods: This is a case controlled randomized study where the patients will be recruited from the PICU and pediatric department, Al-Azhar university hospitals during the period from September 2022 up to end of February 2023. Results: There is higher assisted ventilation use in hyponatremic group than those with normal sodium however this difference was of no statistically significant value. Conclusion: Hyponatremia is common among hospitalized patients with pneumonia and is associated with worsened clinical and economic outcomes. Studies in this large population are needed to explore whether prompt correction of [Na+] may impact these outcomes.


INTRODUCTION
Pneumonia is the single largest infectious cause of death in children worldwide.Pneumonia accounts for 15% of all deaths of children under 5 years old, killing 808 694 children in 2017.The burden Is more common in the developing nations (WHO 2019).
Pneumonia can present in many ways and can also lead to many complications.Hyponatremia (HN) is a common electrolyte disturbance occurring in hospitalized children with pneumonia.(Lussky et al., 2009) HN may result from free water retention, sodium losses or a shift of water from the intracellular to the extracellular compartment, or, correspondingly, a shift of sodium from the extracellular to the intracellular compartment (Moritz ML, Ayus JC, 2002).

Serum
osmolality mainly depends on serum sodium (and corresponding anions), blood urea nitrogen (BUN) and plasma glucose, and it may be low, normal or high in the case of HN (Oh MS, 2002).
The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) leads to water retention; it is one of the most important causes of HN with hypoosmolality and it is usually associated with pulmonary, cerebral or malignant diseases, or with drugs (Adroguè HJ, Madias N, 2000).
One study found 531 children with hyponatremia among 3938 children with respiratory infections with incidence of (13.5%) (Sung Won Park et al., 2018).

AIM OF THE STUDY
The aim of this work to identify the incidence of hyponatremia in children with community acquired pneumonia and to study the impact of hyponatremia regarding the severity of symptoms, duration of hospitalization and outcome of community acquired pneumonia.

Our sample size was calculated according to the following equation: n = N / [1 + N x e 2 ]
Where n=sample size, N =population size, e =margin of error.
A total of 80 patients was estimated to be sufficient sample size.

A written informed consent
was obtained from parents or the legal guardians before the study.
2. An approved by the local ethical committee was obtained before the study.

PATIENTS AND METHODS
This is a case controlled randomized study where the patients will be recruited from the PICU and pediatric department, Al-Azhar university hospitals during the period from September 2022 up to end of February 2023.

The study will include:
The case group:

Inclusions Criteria:
Fifty Children aged 2 months to 5 years' old with signs and/or symptoms compatible with respiratory infection and radiological infiltrations consistent with pneumonia with serum sodium less than 135 mmol/l.
-Patients with chronic underlying illness: renal, thyroidal and adrenal insufficiency.

The control group:
Fifty Children aged 2months to 5 years' old with signs and/or symptoms compatible with respiratory infection and radiological infiltrations consistent with pneumonia with normal serum sodium.
All study children will be subjected to the following: 1. Detailed history, clinical assessment and grading the severity of pneumonia.

RESULTS
Our results will be demonstrated in the following tables: There is no statistically significant difference between the studied groups as regard age, sex.There is no statistically significant difference between laboratory findings of both groups.

, 2020).
There is no statistically significant between the studied groups as regard age and sex.
Similarly, in the study of Haseeb et al., 2019, the mean age was 2.74±1.23 years with 55 (72%) males and 21 (28%) females.There was no statistically significant difference between those with hyponatremia (n=41) and those with normontremia (n=35) as regard to sex.
The present study showed that there is statistically significant higher HR, RR, temperature in hyponatremic group than those with normal sodium while no significant difference in O2 saturation between both groups.There is no statistically significant difference in anthropometry between both groups.There is no statistically significant difference between both groups.
In accordance with our results, study of