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Hyponatremic seizures as a presenting symptom of child abuse
Insights
Water intoxication, a rare form of child abuse, can cause severe hyponatremia and seizures. This case highlights the dangers of using forced water ingestion as punishment, emphasizing the need for awareness among healthcare providers.
Area of Science:
- Pediatrics
- Toxicology
- Child Abuse
Background:
- Poisoning is an infrequent indicator of child abuse.
- Intentional water administration as punishment is a rarely documented cause of poisoning in children.
Observation:
- A 5-year-old girl presented with status epilepticus and severe hyponatremia (serum sodium 107 mEq/l) due to acute water intoxication.
- Physical examination revealed signs of child abuse, including ecchymosis and failure to thrive, with physical parameters matching a 2.5-year-old.
- The child's statement indicated a history of forced water ingestion as a punitive measure.
Findings:
- The patient's severe hyponatremia and cerebral edema were successfully treated with appropriate medical intervention.
- The child demonstrated metabolic stabilization and significant weight gain during hospitalization.
- The mother confessed to using forced water ingestion as a disciplinary tactic.
Implications:
- This case underscores the critical importance of considering water intoxication as a form of child abuse.
- Healthcare professionals must be vigilant in identifying non-accidental trauma and water poisoning in children presenting with unexplained neurological symptoms.
- Early recognition and intervention are crucial for managing severe hyponatremia and ensuring the child's safety and well-being, necessitating protective measures like foster care.
Abstract:
Poisoning is an uncommon manifestation of child abuse. The intentional administration of water to a child as a form of punishment has rarely been reported as the responsible substance among children who have been poisoned. We describe a case of a 5-year-old girl presenting with severe hyponatremia due to acute water intoxication. The patient was brought to the emergency room in status epilepticus. A history was obtained from the child's mother stating that the patient had been playing outside when she collapsed. She had had no known prior illnesses. Laboratory evaluation included a hemoglobin of 10.1 mg%, glucose of 60 mg%, serum sodium of 107 mEq/l, potassium of 3.2 mEq/l and chloride of 71 mEq/l. A CAT scan obtained approximately 1 h after admission revealed generalized cerebral edema. Careful examination of the skin revealed multiple linear ecchymosis of varying ages on the back and thighs and a hand print on the right flank. In addition, the child demonstrated severe failure to thrive with height, weight and bone age compatible with a 2.5-year-old girl. Appropriate therapy for severe hyponatremia was successfully instituted. For the next 12 h she was deeply somnolent, but the following morning was alert and conversant. She stated that she "would be good if she didn't have to drink any more water". The child's mother subsequently admitted that she frequently used water ingestion as a form of punishment. The child stabilized metabolically and demonstrated rapid in-hospital weight gain. She was placed in foster care at discharge and has had no further hyponatremia or seizures.(ABSTRACT TRUNCATED AT 250 WORDS)