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EncefalopatÃa hiponatrémica
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Introducción: la hiponatremia es la anomalÃa electrolÃtica más común en pacientes hospitalizados. Está relacionada con la administración de fluidos hipotónicos en pacientes con niveles elevados de hormona antidiurética. La complicación más grave de la hiponatremia es la encefalopatÃa hiponatrémica, que puede ser fatal, o provocar una lesión cerebral irreversible, si no se trata adecuadamente.
Presentación del caso: lactante de 6 meses de edad, eutrófica, con antecedentes de salud y un desarrollo psicomotor acorde con su edad, que ingresa en el Hospital Pediátrico de Cienfuegos con el diagnóstico de una enfermedad diarreica aguda por rotavirus. Se decidió suspender la alimentación e iniciar hidratación de mantenimiento por intolerancia de la vÃa oral. Se empleó una solución en base a dextrosa al 5 % con 0,18 % de NaCl. Transcurridas 14 horas en la sala, la paciente se traslada a Cuidados Intensivos por convulsiones, que estuvieron relacionadas con hiponatremia severa. Inicialmente el valor del sodio fue normal. En la tomografÃa de cráneo realizada 13 dÃas después presentaba signos de atrofia cortical. Al momento de realizar este trabajo la niña se seguÃa en consulta de FisiatrÃa y NeuropediatrÃa por una cuadriparesia flácida.
Conclusiones: los fluidos hipotónicos siguen siendo recomendados como lÃquidos de mantenimiento en pacientes agudamente enfermos, a pesar de la fuerte asociación entre su uso y el desarrollo de hiponatremia. Es hora de que se dejen de usar fluidos hipotónicos en estados de enfermedad asociados con exceso de hormona antidiurética, pues no existe razón para que esta práctica continúe.  Â
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