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Salt supplements for electrolyte disturbance

Hot weather

High sweat sodium loss in hot weather or associated with fever can lead to sodium loss, particularly in young children with CF. In most children sodium loss is relatively mild, but can lead to children feeling lethargic. For this reason we recommend salt supplements in prolonged hot weather.

All common oral rehydration solutions comes as sachets made up in 200ml of water and contain about 12mmol of sodium per sachet. For a child weighing 12kg, one 200ml sachet per day would therefore provide sufficient extra sodium.

Pseudo-Bartter’s syndrome

In infants with stomas following meconium ileus surgery, sodium loss can be severe and result in poor growth. In these infants low total body sodium results in secondary hyperaldosteronism, and hypokalemic alkalosis (pseudo-Bartter’s syndrome). The treatment for the low potassium is to give both potassium and sodium supplements which may be required for many months. Giving potassium alone will not work as it will be wasted by the kidney. All infants who have stomas following meconium ileus surgery should have frequent urinary sodium measurements - values less than 20mmol/l indicates sodium depletion and the need to supplement sodium.

Renal salt loss

Occasionally children who have had multiple courses of iv aminoglycosides, more complex renal losses of electrolytes can be seen. These need careful evaluation with paired plasma and urinary electrolytes.