소아 중추신경계 감염질환에서 저나트륨혈증 발생의 특징
Hyponatremia in Children with Central Nervous System Infections Department of Pediatrics
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목 적 : 급성 뇌수막염으로 진단된 소아들에서 초기 및 입원 중 저나트륨혈증의 유병률 및 뇌수막염의 다양한 병인이 저나트륨혈증 발생에 미치는 영향을조사하고, 임상 양상과 치료 과정들 중에 저나트륨혈증의 위험 인자를 파악하고자 하였다. 방 법: 2011년부터 2012년까지 부산대학교 어린이병원에서 급성 뇌수막염으로 치료받은 소아들을대상으로 후향적으로 시행하였다. 뇌수막염의 병인에따라 다음 4개 군으로 분류하였다: A군-무균수막염, B군-바이러스 뇌염/수막뇌염, C군-세균수막염, D 군-결핵수막염. 입원 치료 중에 최소 2회 이상 혈청나트륨 농도를 평가하였고 135 mEq/L 미만 저하된경우를 저나트륨혈증으로 정의하였다. 0.45% 식염수 미만 혹은 이상 농도의 수액을 맞은 환자들을 각각 F1군과 F2군으로 구분하였다. 결 과:전체 244명(A군: 185명, B군: 33명, C군: 23명, D군: 3명) 중, 55명(22.5%)에서 저나트륨혈증이 발생하였고, 이들 중 내원 초기의 저나트륨혈증(IH)이 32명, 입원 중 저나트륨혈증이 23명이었다. 초기 발생은 C군(7/23, 30.4%, P=0.010)이 A군(17/185, 9.2%, P=0.001), 혹은 B군(7/33, 21.2 %, P=0.138)에 비해 의미있게 많았다. 입원 중 발생은 B군(9/33, 27.3%, P<0.001)과 D군(2/3, 66.7 %, P=0.001)이 A군(9/185, 4.9%, P<0.001) 혹은C군(3/23, 13.0%, P=0.533)에 비해 유의하게 높았다. 또한 F1군이 F2군에 비해 초기(25.0% vs. 11.6 %, P=0.047) 및 입원 중(28.6% vs. 6.9%, P<0.001) 저나트륨혈증 빈도가 모두 의미있게 높았다. 결 론 : 급성 뇌수막염의 소아들에서 저나트륨혈증이 드물지 않게 발생하였다. 병인에 따른 발생 빈도의 차이가 있으며, 특히 저장성 수액을 피하는 것이저나트륨혈증 발생을 감소시키는데 도움이 될 것으로 사료된다.
Abstract
Purpose : To compare the effect of different etiologies in children with central nervous system (CNS) infections on the incidence of initial and hospital-acquired hyponatremia (IH and HAH) (plasma sodium concentration, PNa .135 mEq/L). Methods : Children with CNS infections during the period between 2011 and 2012 were evaluated retrospectively. Patients were classified into 4 groups: group A, aseptic meningitis; group B, viral meningoencephalitis; group C, bacterial meningitis; group D, tuberculous meningitis. All patients had measured the initial PNa and were retested serially. By the sodium concentration of IV fluid, children were divided into 2 groups: group-I of .0.45% saline in dextrose, and group-II of ≥0.45% saline in dextrose. Results : Of 244 children with CNS infections (group A: 185, group B: 33, group C: 23, and group D: 3), 55 patients (22.5%) revealed IH- or HAH-hyponatremia. IH and HAH was found in 13.1% (32/244) and 9.4% (23/244), respectively. The incidence of IH was significantly higher in group-C (30.4%, P=0.010) than in group-A (9.2%) or group-B (21.2%). HAH was more frequent in group-B (27.3%, P<0.001) and in group-D (66.7%, P=0.001) than in group-A (4.9%) or in group-C (13.0%). Of the patients in group-I, 28.6% (8/28) developed more common HAH compared with 6.9% (15/216) of children in group-II (P<0.001). Conclusion : IH and HAH were relatively common in children with CNS infections and their incidences were distinctly different among patients from different etiologies. It seems that the administration of hypertonic saline can help to reduce the incidence of HAH among children with CNS infections. election
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