There obvious from the history. If the


 There are several causes underlying dysnatremia.

Most significantly areboth the management of dysnatremia and parenteral hydration. In normalstatus,  the normal range of blood sodiumconcentrations are of 135-145 mmol/L. Sodium and its accompanying anions, whichare mainly chloride and bicarbonate, represent for 90% of the extracellulareffective osmolality.

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The plasma water content is a main determinant of thesodium concentration. Dysnatremias may have result in central nervous systemdysfunction. According to the extracellular fluid volume status thehyoponatremia is classified as either hypovolemic or normo-hypervolemic. Inchildren, vasopressin release is triggered by the low effective arterial bloodvolume in case of hypovolemic hyponatremia this is called syndrome ofappropriate anti-diuresis. The primary defect is euvolemic also there isinappropriate increase in circulating vasopressin levels this is calledsyndrome of inappropriate anti-diuresis. To determine presence of hyponatremiamay shows obvious cause such as vomiting or diarrhea. In some status, todiscriminate hypovolemic from normo- hypervolemic hyponatremia may not beobvious due detecturine spot sodium and the fractional sodium clearance.

In state ofnormovolemic, the major defense against developing hyponatremia is the abilityto dilute urine and excrete free-water. There are special causes lead tohypotonic hyponatremia which are hospital-acquired hyponatremia, desmopressin,endurance athlete and diuretics. Hypernatremia is a net water Loss or ahypertonic sodium gain. If sodium concentrations above 160 mmol/ L that causeserious signs. Almost the cause of hypernatremia is always obvious from thehistory. If the cause is not evident, determine of urine osmolality in relationto the effective blood osmolality and the urine sodium concentration.

There aretwo mechanisms prevent developing hypernatremia which are: releasing ofvasopressin and a powerful thirst mechanism. Breastfeeding and diarrhea orvomiting are causes of hypernatremia in outpatient. The major problem ofbreastfeeding is water deficiency. In comparison of the past, the diarrhea orvomiting is less because of presumably to the advent of low solute infantformulas.

V2 antidiuretic hormone receptor antagonists or urea used to managehyponatremia. To provide water and electrolyte requirements in fasting patientsuse intravenous maintenance fluids which is done by Holliday. Intravenousisotonic crystalloid solutions used in children who resistant to initial oralrehydration therapy. Traditionally , mange chronic normo-hypervolemichyponatremia either by restricting water intake or by giving salt. May bereplaced by alternative way that use nonpeptide vasopressin receptorantagonists.

. All in all, pediatricians must aware of the changing epidemiologyof dysnatremia . Also, the hydrated parenterally with the hypotonic solutionswhich recommended by Holliday.

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