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

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The Diagnosis of Salt Poisoning Leading to Hypematraemia in Children – September 2009 out that it was not possible to tell the degree to which the hypertonic feeds had contributed. This report also demonstrated the marked variation in sodium content of milk feeds obtained from mothers attending their routine postnatal check-ups. A case report 165 described 3 children from Chicago, USA, in 1985 with hypernatraemia, the common factor being that the children all had severe psychomotor retardation and had unintentionally been fed undiluted processed foods with extremely high sodium concentrations. The first case was of a 2 year old in care with severe developmental delay and thoracic myelomeningocele. He was admitted with a sodium of 190 mEq/L and evidence of a urinary tract infection. “On careful investigation it was found that for the week prior to admission his foster parents had been feeding him unreconstituted condensed tomato soup with a sodium concentration of 290 mEq/L.” The possible reasons for this were not discussed. The two peer reviewers commented that without further information this could have been due to abuse or neglect. The second case involved a 15 year old with tuberous sclerosis, admitted with a sodium of 169 mEq/L, and whose nursing home staff had been giving him mainly canned pureed foods, with recent mild fluid restriction to help curtail his vomiting. One of the two peer reviewers felt unable to tell from the publication whether this was the cause, noting that there had also been a 3 month history of vomiting and a 20lb weight loss. The third case of an 18-month-old girl with severe perinatal hypoxic ischaemic encephalopathy, fed by gastrostomy, was admitted with a sodium of 153 mEq/L. “The family admitted to financial difficulties… and were feeding the patient almost exclusively undiluted canned Campbell’s Manhandler soup with a sodium concentration of 325 mEq/L.” Neither peer reviewer was able to tell from the publication whether this was correct. One noted that as there was also a history of diarrhoea and vomiting and of weight gain after rehydration, this might be a contributory factor rather than the cause. The other reviewer thought that without further information this could be considered abusive. A very brief letter from Kentucky, USA, in 1991 166 , reported an infant with ‘near fatal’ hypernatraemia when fed undiluted chicken soup. Neither peer reviewer felt that they could tell from the information given in the paper whether the author’s conclusion as to cause was correct. 37
The Diagnosis of Salt Poisoning Leading to Hypematraemia in Children – September 2009 Two case reports from Madrid, Spain, in 2000 167 described children whose parents’ errors had resulted in hypernatraemia and the death of their child. The first case was of a 20 month old girl whose mother had inadvertently added 2 teaspoons of salt rather than sugar to each of two yoghurts (given despite the child’s protests). This resulted in presentation with a seizure and loss of consciousness. Her admission sodium was 195 mmol/L. The mother only gave the information about the error when she was interrogated after the discovery of the hypernatraemia. Neither peer reviewer felt that they could tell from the information given in the paper whether the administration was truly accidental or abusive. The fractional sodium excretion at the time of admission (6 hours after the salt administration) could be calculated from their table 1 as 15% (i.e. markedly above the expected value of
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The differential diagnosis of hypernatraemia in children, with ...

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