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The management of extreme hypernatraemia secondary to salt poisoning in an infant
1Département d'anesthésie-réanimation pédiatrique, Salvator hospital, Marseille, France.
Insights
This case report details a five-week-old infant with extreme hypernatremia due to accidental salt poisoning from a homemade formula. Prompt fluid therapy led to a full recovery without lasting effects.
Area of Science:
- Pediatrics
- Toxicology
- Nephrology
Background:
- Accidental salt poisoning is a rare but serious condition in infants.
- Extreme hypernatremia can result from improper formula preparation.
Observation:
- A five-week-old infant presented with seizures and severe hypernatremia (serum sodium 211 mmol/L).
- Clinical features included moderate dehydration, renal insufficiency, and preserved urine output with high urinary sodium.
- The infant developed seizures and pulmonary edema during intensive care unit (ICU) stay.
Findings:
- Hypotonic dextrose fluid therapy successfully corrected the hypernatremia and dehydration over 48 hours.
- Mechanical ventilation was required for five days due to pulmonary edema.
- Complete recovery was achieved with no sequelae after a ten-month follow-up.
Implications:
- Early recognition and management of salt poisoning are crucial for favorable outcomes.
- Fluid therapy alone is effective in treating hypernatremia due to salt poisoning when renal function is preserved.
- This case highlights the importance of proper infant formula preparation and awareness of potential toxic ingestions.
Abstract:
We describe a five-week-old boy who had seizures and extreme hypernatraemia secondary to ingesting an improper home-made formula. Initial sodium concentration was 211 mmol.l-1. Other clinical and biological features were moderate dehydration and renal insufficiency with generous urine output and high urinary sodium concentration. Fluid therapy with hypotonic dextrose solution corrected the volume deficit in 48 h and progressively decreased the serum sodium concentration. During ICU stay the patient developed recurrent episodes of seizures and pulmonary oedema requiring mechanical ventilation for five days. Recovery was complete with no abnormal sequelae after a ten-month follow-up. Salt poisoning is in unusual cause of extreme hypernatraemia. It can be safely managed with fluid therapy alone if urine output is preserved, with progressive decrease of serum sodium as target. If this condition is recognized, outcome should be favourable.