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

The Diagnosis of Salt Poisoning Leading to Hypematraemia in Children – September 2009
reviewers agreed (one beyond reasonable doubt, the other on balance of probability)
with the authors’ conclusions that the hypernatraemia was due to the misconceived
parental actions.
A case report from Dallas, USA in 1981 207 described mild hypernatraemia and
metabolic alkalosis in a 4 month old associated with the topical use of baking soda
by the parents to treat a severe nappy rash. The admission sodium was [apparently,
extrapolated from the figure] 152 mEq/L, with serum bicarbonate above 35
mmol/L. The authors acknowledge that there is no direct evidence linking the
biochemical findings with the parental actions. Both peer reviewers accepted
beyond reasonable doubt the authors’ conclusions as to cause, but commented that
the mechanism was far from clear.
Sodium bicarbonate as a remedy
A case report from Arkansas, USA in 1981 208 described a 4 month old child whose
grandmother had admitted adding one tablespoon of baking soda to an 8 oz feed
as a home remedy for cold symptoms. The child’s admission sodium was 164
mEq/L. Both peer reviewers agreed with the authors (one beyond reasonable
doubt, the other on the balance of probability) that the hypernatraemia was due to
the grandmother’s administration of sodium bicarbonate (in the context that this
was at the time a popular folk remedy, and therefore given in the mistaken belief
of benefit).
A case report from Chicago, USA in 1987 209 described a 6 week old infant given
water to which baking soda had been added as a treatment for ‘gas’, resulting
in a serum sodium of 160 mEq/L, and a bicarbonate of 41 mEq/L. The mother
had been adding ‘two pinches’ to each 6oz bottle of tap water for the previous 2
days, and the infant had consumed all 12 oz of this mixture. The peer reviewers
agreed with the authors (one beyond reasonable doubt, the other on the balance
of probability) that the hypernatraemia was due to the mother’s administration of
sodium bicarbonate in the mistaken belief of benefit.
A case report from Alabama, USA in 1995 210 described a 6 week old infant whose
mother “periodically had been giving the baby ‘a pinch of baking soda in water’
for 2 days as recommended by the patient’s grandmother to help the baby burp.”
At admission the serum sodium was 180 mEq/L, and with an anion gap of 49
mEq/L. The mother admitted giving the practice of giving baking soda after an
initial denial of having done so. The child recovered and was then followed up for
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