Extreme hypernatremia as a presenting sign of child abuse and psychosocial dwarfism

A 21-month-old girl presented with seizures and a serum sodium concentration of 206 meq/l. She had many of the features of psychosocial dwarfism, including short stature, bizarre eating and drinking habits, absent growth hormone response to arginine and insulin infusion and a rapid weight gain during her hospitalization. During the initial rehydration, the patient's weight gain was only 2 percent of her body weight. This finding probably indicates that her hypernatremia was chronic, did not represent acute dehydration and may well have derived from willful denial of water, although a chronic salt load could not be ruled out. This report further emphasizes that extreme hypernatremia may be the presenting feature of child abuse.