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

More documents

Recommendations

Info

The Diagnosis of Salt Poisoning Leading to Hypematraemia in Children – September 2009 A case report from New York, USA, in 1990 1 reported the death of a child of 2 years following administration of a saline emetic by a babysitter after an accidental nortriptyline pill ingestion by the child. Admission sodium was 202 mEq/L. Fresh subdural and subarachnoid haemorrhages were found at postmortem. One peer reviewer agreed beyond reasonable doubt that this was an error by the babysitter. The other peer reviewer felt that without further information it was not possible to tell whether this was child abuse. A case report from Seattle, USA in 1988 176 described a 3-month-old girl who had been administered baking soda in error by her parents. Her admission sodium was 176 mEq/L, and her bicarbonate 54 mEq/L. “Despite initial denials of giving… bicarbonate to their child by the parents, an analysis of the child’s formula revealed the following electrolytes: Na + 242 mEq/L, K + 13 mEq/L, Cl - 14 mEq/L. Moreover, baking soda was found stored in a can of powdered formula at home in the refrigerator, apparently having been placed there when the customary cardboard container had gotten wet.” Both peer reviewers agreed (on the balance of probability) with the authors’ implied conclusion that the cause was the accidental administration of baking soda. One commented that the possibility of non-accidental harm could not be excluded. Evidence statement There are well described credible instances where errors by parents and professionals have led to significant, sometimes fatal, hypernatraemia secondary to salt, sodium bicarbonate or sodium phosphate administration [Grade C]. The judgements as to whether these episodes were accidental rather than abusive or neglectful are based on the context and circumstances, not the biochemical findings [Grade C]. Evidence statement Measurement of bicarbonate, calcium and phosphate concentrations in the blood as well as sodium and chloride concentrations should assist in distinguishing the different sodium containing substances [Grade D]. Evidence statement In many of the case reports of infants and children being fed inappropriately concentrated feeds the true cause cannot be ascertained with any degree of confidence. There remains the alternative possibility of abuse or neglect [Grade C]. 41
The Diagnosis of Salt Poisoning Leading to Hypematraemia in Children – September 2009 4.2.3 Side effects 4.2.3.1 Side effect of medical treatments Ten children developed hypernatraemia following the deliberate administration of 3% saline as treatment for refractory intracranial hypertension due to head injury. 177 Serum sodium rose to between 157 and 187 mEq/L. One child died, but this was thought to be the result of the severity of the head injury. They concluded that this appeared to be both safe and effective, but considered that controlled trials were needed before widespread use. There are a number of reports of hypernatraemia following the instillation of hypertonic saline into the body cavity during operative removal of hydatid cysts. Most reports are in adults. However, there are case reports in two children, aged 7 and 4 years from South Africa and Spain 178, 179 . Sodiums of 170 and 178 mmol/L resulted. The first child died. Three children, one aged 20 months and the others aged 2 years, two from Australia and 1 from New Zealand 180, 181 , are described receiving saline as an emetic to treat accidental poisoning. They had ingested warfarin, almond oil and pheniramine. Admission sodium concentrations of 176 and 204 mmol/L were recorded in 2 children. All three children died. Sodium phosphate enemas are reported in association with hypernatraemia. Hypocalcaemic tetany is also a frequent occurrence. 182-193 There is one report of a child with hypernatraemia after receiving oral sodium phosphate for rickets. 194 Two cases of hypernatraemia followed the use of antegrade continence enemas (ACE), one using salt water and the other with softened water (softening adds approximately 250 to 300 mg sodium per litre). 195,196 The child receiving salt water died. One child aged 10 months had a sodium concentration of 183 mmol/L after receiving sodium bicarbonate during a cardiac arrest. 176 A 7-month-old child had a sodium of 174 mmol/L after receiving sodium bicarbonate paste administered to 22% chemical burns due to crawling through sodium hypochlorite. 197 The boy died. 42
Page 1 and 2: The Differential Diagnosis of Hyper
Page 3 and 4: The Diagnosis of Salt Poisoning Lea
Page 47: The Diagnosis of Salt Poisoning Lea
Page 99 and 100:
The Diagnosis of Salt Poisoning Lea
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
show all

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

Create successful ePaper yourself

Delete template?

Save as template?