The differential diagnosis of hypernatraemia in children, with ...

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The Diagnosis of Salt Poisoning Leading to Hypematraemia in Children – September 2009 Increased evaporative loss 1. Skin conditions including Netherton syndrome 2. Endurance exercise in marathon runners 3. Lost in the desert or at sea, with increased transepidermal water loss What key tests will help distinguish excess sodium intake from water depletion? “The distinction between accidental and non-accidental salt poisoning cannot be made on clinical or physiological grounds, since the end result of both is the same. Only a meticulous evaluation of the history and the attendant circumstances of the case can resolve this… The two conditions that should be distinguishable on clinical and physiological grounds are hypernatraemic dehydration and salt overload (however induced).” 43 Measurement of urinary sodium concentration does not reliably distinguish dehydration from excess sodium intake. [Grade C] In the absence of renal failure, a raised calculated urinary fractional sodium excretion is indicative of increased sodium excretion by the kidneys. The urinary fractional sodium excretion rates reported in the 3 severely hypernatraemic individuals were all 9.5% or above, well above the upper reported limits in healthy children and in those presenting with gastroenteritis and dehydration. [Grade D] 24 hour urinary sodium excretion rates of up to 11 mmol per kilogram per day have been observed in infants with salt poisoning. In view of the small number of cases reported and the absence of published normal values, particularly in infants, a cut off point above which excessive sodium intake can be inferred cannot be given. [Grade D] How well known among the public is the lethal dose of salt? Most parents would be concerned about the serious risks of giving a dose of salt in the minimum lethal dose range. [Grade C]. 9
The Diagnosis of Salt Poisoning Leading to Hypematraemia in Children – September 2009 Summary of recommended immediate investigations in children presenting with hypernatraemia in whom the differential diagnosis includes possible salt poisoning • Accurate weight measurement at admission and following restoration of full hydration • Simultaneous plasma and urine sodium and creatinine at admission and repeated regularly • Plasma bicarbonate, calcium, chloride and phosphate • Simultaneous serum and urinary osmolality • Sodium concentration of gastric contents 10
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The differential diagnosis of hypernatraemia in children, with ...

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