I have found several cases of hyponatremia ( low sodium chloride in blood) especially elderly patients suffering from respiratory infection with impaired cognitive functions. These patients well responded to oral sodium chloride or ORS ( oral rehydration solution used in diarrheal patient) in conjunction with antibiotics. There cognitive impairment was prevented with early use ORS during respiratory infection and they remain well during winter season. So we can claim that there should be some exaggerated effect on chloride shift during respiratory infection or in other infections which can cause increased PCo2 in blood leading to hyponatremia.
I hope this article contains the answer for your question. We can plan for a RCT to manage those hyponatremia with IV fluid and ORS depending on patients clinical condition and see how is the cognitive outcome in both group.
Regards,
Dr Md Abdul Qader
Associate consultant of Paediatric nephrology
Square hospitals Ltd
Hyponatremia due to respiratory tract infections (pneumonia) is due to the non-osmotic release of antidiuretic hormone (aka SIADH). This has nothing to do with chloride shifting. The key in management is to determine if the hyponatremia is acute or chronic. In acute Hyponatremia, the goal is to rapidly increase the serum sodium concentration because of the risk of cerebral edema and brain herniation. In chronic Hyponatremia, the goal is to increase the serum sodium more gradually (not exceeding 8 mmol/L/day) because of the risk of causing osmotic demyelination syndrome.
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