Cultivated child abuse: a 2-year-old with hyponatremic seizures

Area of Science:

• Pediatric Neurology
• Clinical Toxicology
• Child Abuse Pediatrics

Background:

• Hyponatremia, defined as serum sodium < 135 mEq/L, is a common electrolyte disturbance in children.
• Seizure threshold is significantly lowered with serum sodium levels ≤ 125 mEq/L.
• Diagnosis involves differentiating hypovolemic, euvolemic, and hypervolemic hyponatremia via laboratory studies.

Observation:

• A 2-year-old girl presented with recurrent seizures due to severe hyponatremia, requiring multiple resuscitations.
• Initial differential diagnoses included salt-wasting renal disease, adrenal insufficiency, and syndrome of inappropriate antidiuretic hormone secretion.
• The clinical presentation evolved, revealing an atypical etiology.

Findings:

• The patient's recurrent hyponatremic seizures were ultimately attributed to an uncommon form of child abuse.
• This case underscores the importance of considering non-accidental trauma in unexplained hyponatremic seizures.
• Diagnostic challenges arise when hyponatremia mimics other pediatric conditions.

Implications:

• Clinicians must maintain a high index of suspicion for child abuse in cases of unexplained recurrent hyponatremia and seizures.
• Early recognition and intervention are crucial for improving outcomes in pediatric hyponatremia secondary to abuse.
• This case contributes to the understanding of rare presentations of child abuse and their diagnostic complexities.