Extreme hypernatremic dehydration due to potential sodium intoxication: Consequences and management for an infant with diarrhea at an urban intensive care unit in Bangladesh: A case report

Das, Sumon Kumar, Afroze, Farzana, Ahmed, Tahmeed, Faruque, Abu Syed Golam, Sarker, Shafiqul Alam, Huq, Sayeeda, Islam, M Munirul, Shahrin, Lubaba, Matin, Fariha Bushra and Chisti, Mohammod Jobayer (2015) Extreme hypernatremic dehydration due to potential sodium intoxication: Consequences and management for an infant with diarrhea at an urban intensive care unit in Bangladesh: A case report. Journal of Medical Case Reports, 9 124: . doi:10.1186/s13256-015-0611-y


Author Das, Sumon Kumar
Afroze, Farzana
Ahmed, Tahmeed
Faruque, Abu Syed Golam
Sarker, Shafiqul Alam
Huq, Sayeeda
Islam, M Munirul
Shahrin, Lubaba
Matin, Fariha Bushra
Chisti, Mohammod Jobayer
Title Extreme hypernatremic dehydration due to potential sodium intoxication: Consequences and management for an infant with diarrhea at an urban intensive care unit in Bangladesh: A case report
Journal name Journal of Medical Case Reports   Check publisher's open access policy
ISSN 1752-1947
Publication date 2015-06-02
Year available 2015
Sub-type Article (original research)
DOI 10.1186/s13256-015-0611-y
Open Access Status DOI
Volume 9
Issue 124
Total pages 6
Place of publication London, United Kingdom
Publisher BioMed Central Ltd
Collection year 2016
Language eng
Formatted abstract
Introduction
Hypernatremia (serum sodium ≥150mmol/L) is one of the most life-threatening complications of childhood diarrhea, and its management remains challenging, even in a highly advanced critical care setting. This case report describes the acute clinical course and 3-month neurological follow-up after discharge of an infant with extreme hypernatremia in an intensive care unit in Dhaka, Bangladesh.

Case presentation
A 6-month-old Asian Bangladeshi girl of middle-class socioeconomic status was admitted to the intensive care unit of our institution in 2012 with acute watery diarrhea, lethargy and hypernatremia (208mmol/L serum sodium). She had a history of taking excess oral rehydration salt: five packets each, inappropriately prepared, rice-based, properly diluted, glucose-based oral rehydration salt. Her hypernatremia was treated exclusively with oral rehydration salt solution. She experienced seizures on the third day of her hospitalization and was treated with anticonvulsant drugs. Later in the course of her hospitalization, Enterobacter spp bacteremia was detected and successfully treated with ciprofloxacin. Although magnetic resonance imaging of her brain at discharge showed cerebral edema, brain magnetic resonance imaging appeared normal at a follow-up examination 3 months after discharge. Electroencephalograms taken at discharge and at her 3-month follow-up examination also appeared normal.

Conclusions
Successful management of extreme hypernatremia with only oral rehydration salt did not result in observable neurological consequences, which emphasizes the importance of the use of oral rehydration salt for the clinical management of childhood hypernatremia.
Keyword Bangladesh
Diarrhea
Hypernatremia
Infant
Oral rehydration salt
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Public Health Publications
 
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