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

The Diagnosis of Salt Poisoning Leading to Hypematraemia in Children – September 2009
mmol/L, and who died despite attempts at resuscitation. The description of the case
was very brief: “A 4 year old girl ingested, according to her parents, some bathing
foam when she was taking a bath. Her parents made her drink several glasses of
saturated sodium chloride solution (exact amount unknown) to induce emesis, which
was successful within minutes. The girl became very sleepy shortly afterwards, and
her parents took her to bed. Two hours later, she was unresponsive and had seizures
and her parents took her to hospital… Furthermore [at autopsy], signs of neglect
were present, namely a very low body weight of 9.4kg [2.6 kg below 0.4 th percentile]
at a size of 99cm [25 th percentile].” Both peer reviewers disagreed with the authors’
conclusion that the salt administration was the result of an attempt at treating the bath
foam ingestion, and on the balance of probability thought that this was more likely
to be child abuse.
Excessive quantities of oral rehydration solution
A 6-month-old infant in Navarra, Spain, received very large quantities (5 litres in
18 hours) of oral rehydration solution made up correctly, with a sodium content
of 90mmol/L, to treat mild diarrhoea and vomiting. 204 His admission sodium was
161 mmol/L. The calculated sodium intake prior to admission was 93 mmol/kg
per day.
Application of salt or bicarbonate to the skin
A case report from Turkey in 1993 205 describes the death of an infant following a
cultural practice of applying salt to the baby’s skin. The infant had been irregularly
salted since birth either by direct application to the skin or by adding the salt to
the swaddling material. The infant presented at 30 days of age with a seizure,
and was found to have a serum sodium of 190 mmol/L. The infant died despite
fluid therapy. The salting of babies skin is reportedly an old custom in Turkish
communities, with the probable purpose that healthy skin would result from the
application and subsequent removal of the salt. Both peer reviewers agreed on
the balance of probability with the authors’ conclusion that the hypernatraemia
resulted from this practice. However, this is a purely descriptive case report
without the information that would help to corroborate the mechanism.
A report from Israel in 1986 206 describes a 3-year-old child whose parents covered
the child’s 25% burns with salt crystals in an attempt to cure the burn injury. The
child’s sodium at admission was 200 mmol/L, and the child subsequently died. The
practice was apparently known to be used in the “primitive community”. Both peer
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