ESPE Abstracts

Background: Electrolyte imbalance is often encountered in hospitalized patients, with hyponatremia being the most frequent and potentially the most diverse in regards to its etiology, with endocrine causes representing a high proportion. However, the prevalence of hyponatremia in the general pediatric population is still unknown, as the available studies have focused on admitted patients in acute conditions.

Aim: The aim of the current study was to assess the prevalence of electrolyte imbalances in a Pediatric Endocrinology Department in non-acute settings.

Material and methods: This was a secondary data analysis of pediatric patients evaluated in a tertiary Endocrinology center from Romania. Electronic health records of all pediatric patients admitted in 2023 in the Endocrinology Department of the Mures County Hospital, Romania were assessed. Subjects with electrolyte evaluation were included in the analysis. Variables analyzed – age, gender, environment, diagnosis, sodium, potassium, estimated glomerular filtration rate, glucose, triglycerides, cortisol and TSH levels. Data was analyzed using SPSS v25 with a level of significance α=0.05.

Results: A total of 833 scheduled visits were recorded for 519 subjects. The main diagnoses were short stature (20.6%), overweight/obesity (20.2%), hypothyroidism (9.3%) and precocious puberty (6.9%), with adrenal failure confirmed in only 2.4% of cases and no endocrine dysfunction in 20.2%. Eighty-nine percent of patients had an electrolyte panel assessment. Prevalence of hyponatremia was 4.04% and hyperkalemia 11.3%, with higher frequency in girls, but with only one case of adrenal failure diagnosed. Seventy-five percent of the hyperkalemia cases were in children below age 3. Low cortisol levels were present in 79.4% of the cases, with a mean value of 8.2 ± 3.7µg/dl, with only one confirmed new case of adrenal failure at subsequent evaluations.

Discussions and Conclusion: The prevalence of incidental hyponatremia in pediatric patients is lower when considering non-acute settings and is rarely a sign of adrenal failure in asymptomatic patients. Low cortisol levels are frequent in the pediatric population at the initial assessment, but are usually not confirmed at subsequent evaluations. More emphasis should be put on targeted assessment in pediatric endocrine patients in non-acute settings as per avoidance of unnecessary stress and complex investigations.

Keywords: hyponatremia, hyperkalemia, non-acute setting