Case report: Severe hyponatremia in infants with urinary tract infection

Abu Bakar, Karmila and Jalaludin, Muhammad Y. and Zainal, Nur and Woon, Sze L. and Zikre, Nurwahida Mohd and Samingan, Nurshadia and Ab Rahman, Syaza and Eng, Caroline S. Y. (2021) Case report: Severe hyponatremia in infants with urinary tract infection. Frontiers in Pediatrics, 9. ISSN 2296-2360, DOI

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Introduction: Many reports on investigations and treatments in UTI, however little, have been mentioned with regard to electrolyte abnormalities. Secondary pseudohypoaldosteronism (PHA) in UTI, though less common, is a known association. Features include hyponatremia and concomitant hyperkalemia. Objectives: We aim to highlight these uncommon sequelae in UTI to avoid incorrect diagnosis and unnecessary investigations. Study Design: Clinical data of patients admitted and referred to a pediatric nephrologist at the University Malaya Medical Center between May 2019 and October 2020 were collated and elaborated. Results and Discussion: We report three infants with hyponatremia and hyperkalemia during UTI episodes. Two infants were known to have posterior urethral valve (PUV) before the onset of UTI and one infant had UTI, which led to investigations confirming the diagnosis of bladder vaginal fistula. The electrolyte derangements were temporary and resolved within 48 to 72 h of treatment with intravenous fluid and appropriate antibiotic therapy. Out of three, only one had a hormonal study, which confirms PHA. Reduced aldosterone activity could be due to absolute reduction in aldosterone titer or lack of aldosterone responsiveness at tubular (other tissues) level. In the latter, aldosterone titer is elevated. The infant in our cohort who had hormonal evaluation had the mentioned electrolyte abnormalities with a markedly elevated aldosterone titer. This demonstrated defective action of the hormone at the level of mineralocorticoid receptor. Although the remaining two infants had no confirmatory hormonal study, all of them recovered within 48 h of hospital admission, after receiving appropriate management for the primary problem, which was UTI. We observed a slower recovery of hyponatremia in relation to hyperkalemia, but none of these infants required salt replacement upon discharge. Conclusion: Infants with severe UTI and deranged electrolytes should be screened for structural abnormality and vice versa. Not all infants require hormonal screening, but those who required prolonged salt replacement or showed involvement of other systems warrant further evaluation.

Item Type: Article
Funders: None
Uncontrolled Keywords: Hyponatremia; Hyperkalemia; Urinary tract infection; Pseudohypoaldosteronism; Congenital anomaly of kidney and urinary tract (CAKUT)
Subjects: R Medicine > RJ Pediatrics
Divisions: Faculty of Medicine
Depositing User: Ms Zaharah Ramly
Date Deposited: 12 Jul 2022 04:23
Last Modified: 12 Jul 2022 04:23

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