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

The Diagnosis of Salt Poisoning Leading to Hypematraemia in Children – September 2009
• Vomiting and diarrhoea
• Peripheral circulatory failure
• Sunken eyes
• Respiratory depression
• GI and heel prick bleeding
Two of the 5 infants between 4 weeks and 7 months had refused feeds, one with accompanying
weight loss of 10% of his body weight with clinical dehydration. One was reported as
showing intense thirst. Two were drowsy and lethargic; three became comatose (one further
was found dead). Two infants vomited. Three were seen to fit, have extensor spasms or be
“on the verge of fitting”.
The ten children in whom symptoms are described all became comatose, some very
quickly (one within 15 minutes of receiving the saline emetic). Eight had seizures. Six
had documented pyrexia. Three were documented as having vomited, one further child
complained of feeling nauseated. Three had circulatory shock. Three had some degree of
respiratory distress. One had bloody, fluid stools.
There are 10 case reports in the literature in which a patient has been documented to receive
salt or saline, and a blood glucose on admission is available. Patients were excluded with preexisting
conditions such as diabetes or Cushing’s disease, as well as those in whom additional
158, 161, 167, 202, 223-229.
glucose was also given (e.g. glucose in oral rehydration solutions).
The average blood glucose on admission was 9.4 mmol/L, with a standard deviation of
3.5 mmol/L. Seven of the 10 had a blood glucose above 8.0 mmol/L. The highest blood
glucose was 17.3 mmol/L in a child whose mother had added salt instead of sugar to two
yoghurts. The average sodium was 193 mmol/L, range 166 to 212 mmol/L.
Evidence statement
The onset of coma can be rapid following salt ingestion [Grade C].
Evidence statement
Some children poisoned with salt have a modestly raised blood glucose [Grade C].
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