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

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The Diagnosis of Salt Poisoning Leading to Hypematraemia in Children – September 2009 Royal College of Paediatrics and Child Health Royal College of Paediatrics and Child Health publication “The Diagnosis of Salt Poisoning Leading to Hypernatraemia in Children” is for use by health professionals working in the field of child protection. It is based on the best available evidence. New evidence, at any time, could invalidate the findings and it is therefore the reader’s responsibility to keep up to date with the literature. It is expected that the reader will be relying on appropriate professional knowledge and expertise to interpret the contents in the context of the circumstances of the individual child. The publication should be used in conjunction with other appropriate and up-to-date literature and, where necessary, supplemented by expert advice. Responsibility for appropriate practice lies solely with the individual health professional. iii
The Diagnosis of Salt Poisoning Leading to Hypematraemia in Children – September 2009 CONTENTS Guideline Development Group members................................ 1 Summary of guidance...............................................................3 1. Introduction................................................................... 11 2. Methodology..................................................................14 3. Incidence of hypernatraemia....................................... 23 3.1 Incidence of hypernatraemia in children in the UK.................. 23 3.2 Incidence of hypernatraemia secondary to child abuse in the UK.................................................................................. 25 3.3 Probability of a child presenting with hypernatraemia being the subject of non-accidental salt poisoning............................ 25 4. Causes of hypernatraemia........................................... 26 4.1 Causes of hypernatraemia in children (and adults) other than excessive sodium intake.................................................. 26 4.2 Mechanisms causing hypernatraemia through accidental excessive sodium intake.......................................................... 33 4.3 Characteristics of children with hypernatraemia in whom accident was the likely cause.................................................. 51 4.4 Mechanisms causing hypernatraemia through non-accidental excessive sodium intake................................. 53 4.5 Characteristics of children with hypernatraemia considered to have been abused............................................................... 67 4.6 Additional causes of hypernatraemia in adults........................ 69 4.7 Excessive sodium administration without hypernatraemia...... 71 5. Lethal dose of salt.........................................................72 5.1 What is thought to be a lethal dose of salt?............................. 72 5.2 How is the dose of sodium required to raise the serum sodium by a specified amount calculated?.............................. 72 5.3 How well known among the public is the lethal dose of salt?.. 74 iv
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The differential diagnosis of hypernatraemia in children, with ...

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