HYPERNATRAEMIA - THE DRY OR SALTY CHILD
Narasimhaiah D, Shires H, El-hadi S Princess Wales Hospital, Bridgend. Corresponding Author: Deepa Narasimhaiah, 231, Champs-Sur-Marne, Bradley Stoke, Bristol BS32 9BY U.K. Email: firstname.lastname@example.org Key words:Hypernatremic dehydration, Salt poisoning.
Hypernatremia is defined as a serum sodium concentration of >145mmol/l and is a relatively uncommon finding in a child with dehydration. Severe hypernatremia is very rare and can be classified as a sodium concentration of >200mmol/l. In this article we present one such unusual case.
A 10 week old male infant presented to A&E at midnight with a few hours history of poor feeding, irritability and rapid breathing. On arrival, the infant was noted to be markedly tachypnoeic and tachycardic with mottled peripheries. He was initially resuscitated with intravenous fluid boluses and admission blood tests revealed a sodium concentration of greater than 200mmol/l. Further tests revealed a urea of 11.9 and creatinine of 49 with a normal potassium concentration. The infant had a normal anion gap compensated metabolic acidosis with a pH of 7.3. Further history taking revealed the infant to be fed with formula milk, mother had mild learning difficulties and consequently feeds were often reconstituted by other family members. Analysis of m ilk powder from the tin currently in use was found to be excessively high in salt with a sodium content of 843mmol/l (normal content of standard formula 30mmol/l) and a chloride of 833mmol/l (normal 50mmol/l). A diagnosis of salt poisoning was confirmed prompting referral to social services and a full enquiry.
Salt poisoning is a rare but extremely important cause of severe hypernatremia, where the consequences of diagnosis can have devastating outcomes for the family. Differentiating between accidental and non-accidental poisoning is highly problematic. Management of the resulting hypernatremia includes meticulous history-taking, serial measurement of serum and urinary electrolytes, exclusion of metabolic causes and carefully monitored fluid management. Last updated: 1-02-2007 Vol 4 Issue 2 Art # 7
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Narasimhaiah D, Shires H, El-hadi S. Hypernatraemia - The Dry or Salty Child Pediatric Oncall [serial online] 2007 [cited 2007 February 1];4. Art # 7. Available from: