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

The Diagnosis of Salt Poisoning Leading to Hypematraemia in Children – September 2009
7. Recommendations for further research
Case reports
This guideline has confirmed that case reports are crucial to an appreciation of the range of
causes for children presenting with hypernatraemia. As previously stated it is particularly
difficult to undertake research into child abuse, and the best available evidence will continue
to come from case reports.
When the diagnosis is of non-accidental injury, parental consent for publication is very
unlikely to be obtained. A recently published letter 306 highlights the difficulties in getting
case reports of factitious illness in children published in UK journals without parental
consent. The guideline group recommends that a mechanism for publishing such case
reports be established to avoid publication bias whilst maintaining patient confidentiality.
It is equally important to ensure publication of case reports concerning children in whom
the diagnosis of salt poisoning was seriously considered but excluded. In particular
publication is crucial where otherwise healthy young children were shown to have
voluntarily ingested sufficient salt to render them hypernatraemic.
It is recommended that case reports should be prepared with sufficient detail to allow peer
review as undertaken for this guideline.
Normal values for fractional excretion of sodium
Although some studies have already been undertaken from which normal values for the
fractional excretion of sodium can be extrapolated in children of different ages, the numbers
of subjects are still small, and further studies are recommended in normal children.
Further studies of fractional excretion of sodium in children presenting with other causes
of hypernatraemia including hypernatraemic dehydration are recommended.
Studies of sodium excretion rates
Further research into sodium excretion rates in normal infants and children and those with
other causes of hypernatraemia including hypernatraemic dehydration are recommended.
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