was NEW HYPONATREMIA IN BRONCHIOLITIS.pptx

bronchiolitis

1. A prospective observational study on association between serum sodium level and severity of bronchiolitis among children admitted in intensive care unit DR. R. RAMYA 1 YEAR POSTGRADUATE DEPT. OF PAEDIATRICS

2. DEFINITION Bronchiolitis is a diagnostic term given to describe clinical picture produced by several different viral lower respiratory tract infections in infants and very young children. Generally ,Bronchiolitis is inflammation of bronchiolar mucosa Commonly occurring in children less than 18 months of age ETIOLOGY Mostly viral origin Respiratory Syncytial Virus(RSV) Adenovirus Parainfluenza virus Influenza virus

3. SYMPTOMS

4. PATHOPHYSIOLOGY Inflammation of bronchiolar mucosa Bronchiolar obstruction due to edema,mucus,cellular debris. Increased resistance in airway leading to wheeze,air trapping and lung hyperinflation. if obstruction becomes complete atelectasis occurs hypoxemia , ventilation perfusion mismatch. severe obstructive disease leading to PICU admission

5. BACKGROUND AND JUSTIFICATION Bronchiolitis is the leading cause of hospitalization in infants, accounting forApproximately 10% to 15% of these 5% to 6% children require intensive care. Retrospective studies of children hospitalized to the ICU reported associations between hyponatremia ( themost common electrolyte abnormality in ICUs) and more severe disease course. C hildren with pneumonia also suggested associations of hyponatremia with higherseverity of illness Hyponatremia occurs due to In appropriate secretion of ADH . Hypotonic fluid administration

6. Inappropriate secretion of ADH occurs due to hyperinflation of lung Secretion of inflammatory mediators IL- 6 Decrease venous return affect hypothalamo - pituitary axis Increase ADH secretion HYPONATREMIA It remains unclear whether this condition independently predicts higher severity in children with bronchiolitis. To address this knowledge gap I am doing this study.

7. AIMS AND OBJECTIVES AIM: To correlate the association between serum sodium levels and course of bronchiolitis in children admitted in PICU. PRIMARY OBJECTIVE: To correlate the association hyponatremia between severity of bronchiolitis.

8. METHODS STUDY DESIGN : PROSPECTIVE OBSERVATIONAL STUDY AT TKMCH SAMPLE SIZE : 100 CHILDREN ADMITTED IN PICU INTERVAL : 18 months

9. Methodology INCLUSION CRITERIA Children admitted with c/o cough and cold ,fast breathing with retractions less than 2 yrs. EXCLUSION CRITERIA Children with Sr. Na* levels > 145 meq /l. Children with similar complaints mimicking features of bronchiolitis (broncho pneumonia). X ray chest showing features of pneumonia.

10. METHODOLOGY CASE DEFINITION: All those children admitted in PICU at TKMCH with C/O cough , C/O fast breathing , C/O difficulty in breathing Chest X ray showing hyperinflation of lung fields are taken After getting informed consent , demographic details of the patient age ,sex, detailed history, a detailed examination is done. Then child classified into mild, moderate , severe by severity score Then serum levels of sodium are taken at the time admission. Children will be separated into two groups - NORMONATREMIC AND HYPONATREMIC based on values of sr. Na* at the time admission.

11. Sodium levels for comparison Chest X ray - showing hyperinflation of lungs

12. SEVERITY SCORE Score 1 Score 2 Score 3 Respiratory rate 1- 2 months > 2months- 1 year >1 year < 60 < 50 < 40 61-69 51-59 41-44 > 70 > 60 > 45 Cyanosis normal Peripheral Central Saturation 94-100% 90- 93% < 90% Sensorium mild irritability but easy to console difficult to console lethargy, drowsy nasal flare/retractions 1 2 <3 Feeding normal > 50% < 50% Air entry/ wheeze Normal, scattered crepitations Coarse rhonchi in Both expirations Fair rhonchi, poor Expiration grunt.

13. Interpretation < 7 = Mild 8 – 14 = Moderate 15 – 21 = Severe

14. ANALYSIS The association between hyponatremia and severity of bronchiolitis can be assessed by severity score ,measuring the use of mechanical ventilation and length of stay (LOS). By measuring the levels of sodium at the time of admission we can easily Predict the children those who will become worse, which will help us to do continuous monitoring and early intervention can be done.

15. References Rudhan , Rachel & Biswal, Niranjan. (2019). Simplified bronchiolitis severity score for health care providers. International Journal of Contemporary Pediatrics. 6. 1259. 10.18203/2349-3291.ijcp20192024. Voets , Serge; van Berlaer , Gerlant ; Hachimi-Idrissi , Said. Clinical predictors of the severity of bronchiolitis. European Journal of Emergency Medicine 13(3):p 134-138, June 2006. | DOI: 10.1097/01.mej.0000206194.85072.33

16. PROFORMA Name Age Sex Chief complaints General examination Severity assessment Respiratory rate cyanosis Saturation Sensorium Nasal flare/ Retractions Feeding Air entry/ Added sounds Lab investigations X ray chest Serum Sodium

17. Need of Nasal O2 prongs: Need of HFNC: No. of days in O2: No. of days in Hospital: Outcome

18. CONSENT FORM DATE: Title of the project : A prospective observational study on association between serum sodium levels and severity of bronchiolitis amoung children in PICU. Name of the principal investigator: R.RAMYA The contents of the information sheet date that was provided has been carefully read by me , explained in detail to me, in a language that I comprehend and I have fully understood that I have the opportunity to ask questions. The nature and the purpose of the study and its potential risks or benefits and expected duration of the study and relevant details of the study have been explained to me in detail.I understand that my participation is voluntary and I am free to withdraw at any time without giving any reason.

19. I understand that the information collected about me amd my participation in this research and sections of any of medical notes may be looked ay by the responsible individual from care .I give permission for this individual to have access to my records. I agree to start to take part in the above study. Signature Date This is to certify that the above consent has beebn obtained in my presence.

20. THANK YOU