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In conjunction with the tremendous medical advances of the past century, an increasing number of hospitalized patients are dependent on parenteral fluids. Caring for children who have complex medical conditions has resulted in new challenges for prescribing parenteral therapy to maintain sodium and water homeostasis; most electrolyte disturbances occur in the hospital. Although the kidneys play an important role in the development of disorders in water handling, most of the morbidity and mortality results from central nervous system dysfunction (Table 1). This review discusses common disorders of water metabolism, emphasizing the neurologic sequelae.

Hyponatremia is defined as a serum sodium level less than 135 mEq/L (135 mmol/L). It is one of the most common electrolyte disorders encountered in hospitals, occurring in approximately 3% of hospitalized children. The cause usually is identified easily, and the condition rarely is fatal, but sometimes...

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