P85 21 Month old infant with severe hyponatremia caused by excessive water intake during febrile infection. Management and discussion of the case. (June 2019)

• Record Type: Journal Article
• Authors: Anastasiou-Katsiardani, Anastasia; Tsakos, Konstantinos; Beslika, Angeliki; Lampri, Maria; Tanou, Kalliopi; Kastamoulas, Michail; Lykopoulou, Evaggelia
• Is Part Of: Archives of disease in childhood. Volume 104:(2019)Supplement 3
• Page Start: A190
• Page End: A190
• Publication Date: 2019-06
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2019-epa.440
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Introduction: Hyponatremia is the most common electrolyte disorder, defined as a serum sodium level less than 135 meq/L. It is classified according to serum sodium concentration as mild, moderate and severe and according to its manifestation time in acute (<48 hours) and chronic. It can lead to a wide range of symptoms, from mild to severe, even life-threatening (cerebral edema). Purpose: Discussion and management of a case of a 21 month old female infant with severe hyponatremia (Na: 117 meq/L), presented with drowsiness accompanied by polydipsia and polyuria following a febrile infection. Clinical case: The infant presented with drowsiness started 12 hours ago, accompanied by polydipsia (water intake >7 Lt/day), polyuria and high temperature up to 39.8°C that started 3 days ago. From the medical history high water intake is reported from the age of 6 months old. At the time of admission, she was haemodynamically stable, afebrile, presented with tonsillitis and signs of mild dehydration. Laboratory tests revealed severe hyponatremia (Na: 117 meq/L), dehydration with normal renal function tests, low serum and urine osmolarity and normal white blood cell count and CRP. Kidney-ureter-urinary bladder-adrenal gland ultrasound and fundoscopy showed no pathological findings. The patient was treated with intravenous fluids based on the hypotonic dehydration treatment protocol, with continuous neurological, blood gas and biochemical monitoring. Serum sodium levels recovered to normal (Na: 136 meq/L) over the following 24 hours. On the third day of hospitalization she was transferred to the Childrens' Hospital of Athens 'Agia Sofia' in order to complete further investigations to exclude possible adrenal or pituitary gland disfunction and cystic fibrosis disease, which revealed no pathological findings. As a result, the most likely cause of hyponatremia was considered to be the excessive water intake. Conclusions: We presume high water intake as the most likely cause of hyponatremia for our patient, after having excluded other causes of hyponatremia. Although high fluid intake is considered to be a rare cause of hyponatremia in childhood, based on published data, it has to be included in the differential diagnosis. The detailed medical history, the clinical examination and laboratory tests lead to early diagnosis. The cautious correction of serum sodium levels, as well as of co-existent acid-based disorders, is the mainstay of successful treatment of such a potentially life-threatening condition