A child develops headache, vomiting, and confusion after receiving hypotonic IV fluids following surgery. Is this true hyponatremia? Could it be pseudohyponatremia? Or is there another explanation?

In this episode of Kidney Kids: A Guide to Pediatric Nephrology, we explore the evaluation of pediatric hyponatremia, including pseudohyponatremia, hypertonic hyponatremia in diabetic ketoacidosis, and the three major categories of hypotonic hyponatremia based on volume status. We also discuss neonatal physiology, water intoxication, SIADH versus cerebral salt wasting, and the landmark 2018 American Academy of Pediatrics guideline recommending isotonic maintenance IV fluids for most hospitalized children.

Coming up next: Learn how to safely manage hyponatremia—including when to use 3% hypertonic saline, how quickly sodium should be corrected, strategies to prevent osmotic demyelination syndrome, and an approach to pediatric hypernatremia.

Selected References:

• Feld LG, et al. Clinical Practice Guideline: Maintenance Intravenous Fluids in Children. Pediatrics. 2018.

• Moritz ML, Ayus JC. Prevention of Hospital-Acquired Hyponatremia: A Case for Using Isotonic Saline. Pediatrics.

• Adrogué HJ, Madias NE. Hyponatremia. New England Journal of Medicine.

Have feedback, corrections, or suggestions for future episodes? We'd love to hear from you at [email protected].

Disclaimer: Kidney Kids is an educational podcast for medical students, pediatric residents, pediatric nephrology fellows, advanced practice providers, and practicing clinicians. The conversations use AI-generated voices portraying fictional physicians. This content is intended for educational purposes only and should not replace clinical judgment, institutional protocols, or consultation with qualified healthcare professionals.