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

The Diagnosis of Salt Poisoning Leading to Hypematraemia in Children – September 2009
Evidence statement
Subdural haemorrhage occurs only in a small minority of cases of salt
poisoning [Grade C].
Evidence statement
Most reported cases of coexisting subdural haemorrhage and hypernatraemia
are non-accidental, and in several children the evidence suggests that the
subdural haemorrhage preceded deliberate salt poisoning [Grade C].
Evidence statement
The finding of a subdural haemorrhage in association with hypernatraemia
should raise the suspicion that the cause may be non-accidental injury [Grade
C].
4.5 Characteristics of children with hypernatraemia considered to
have been abused
Clinical question
What are the clinical characteristics of children with hypernatraemia reported in the
literature in whom child abuse was considered to be the cause?
The 29 children in whom the authors considered that child abuse was the cause 5 had the
following clinical characteristics:
Age at first presentation: Mean 3 years 8 months (range 2 months to 7 years
2 months). All but one of the Meadow cases 3 were
under 1 year at first presentation.
Sodium at presentation: Mean sodium 196 mmol/L (range 150 to 234
mmol/L). This excludes 5 of Meadow’s cases, where
the exact sodium was not reported. The distribution
including all cases is shown below:
5
Refs 219, 224, 225, 230-232, 233 (case1), 234-239
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