There Intravenous maintenance fluids, Oral rehydration therapy, isotonic


There are several causes underlying dysnatremia. Most significantly are
both the management of dysnatremia and parenteral hydration. In normal
status,  the normal range of blood sodium
concentrations are of 135-145 mmol/L. Sodium and its accompanying anions, which
are mainly chloride and bicarbonate, represent for 90% of the extracellular
effective osmolality. The plasma water content is a main determinant of the
sodium concentration. Dysnatremias may have result in central nervous system
dysfunction. According to the extracellular fluid volume status the
hyoponatremia is classified as either hypovolemic or normo-hypervolemic. In
children, vasopressin release is triggered by the low effective arterial blood
volume in case of hypovolemic hyponatremia this is called syndrome of
appropriate anti-diuresis. The primary defect is euvolemic also there is
inappropriate increase in circulating vasopressin levels this is called
syndrome of inappropriate anti-diuresis. To determine presence of hyponatremia
may shows obvious cause such as vomiting or diarrhea. In some status, to
discriminate hypovolemic from normo- hypervolemic hyponatremia may not be
obvious due detect
urine spot sodium and the fractional sodium clearance. In state of
normovolemic, the major defense against developing hyponatremia is the ability
to dilute urine and excrete free-water. There are special causes lead to
hypotonic hyponatremia which are hospital-acquired hyponatremia, desmopressin,
endurance athlete and diuretics. Hypernatremia is a net water Loss or a
hypertonic sodium gain. If sodium concentrations above 160 mmol/ L that cause
serious signs. Almost the cause of hypernatremia is always obvious from the
history. If the cause is not evident, determine of urine osmolality in relation
to the effective blood osmolality and the urine sodium concentration. There are
two mechanisms prevent developing hypernatremia which are: releasing of
vasopressin and a powerful thirst mechanism. Breastfeeding and diarrhea or
vomiting are causes of hypernatremia in outpatient. The major problem of
breastfeeding is water deficiency. In comparison of the past, the diarrhea or
vomiting is less because of presumably to the advent of low solute infant
formulas. V2 antidiuretic hormone receptor antagonists or urea used to manage
hyponatremia. There are factors used to management of dysnatriemia by using parenteral
hydration are Intravenous maintenance fluids, Oral rehydration therapy, isotonic crystalloid and restricting water intake or by
giving salt. All in all, pediatricians must aware of the changing epidemiology
of dysnatremia . Also, the hydrated parenterally with the hypotonic solutions
which recommended by Holliday.