Two unusual pediatric cases of dilutional hyponatremia

Pediatric Emergency Care
Sanne BoetzkesPhilippe G Jorens

Abstract

Dilutional hyponatremia, although not uncommon, is an underestimated problem in the pediatric population. In most cases, it results from excessive hydration or water retention, also described as the so-called water intoxication. One of the most known causes is the use of desmopressin in enuretic children. This drug enhances the free water reabsorption in the renal collecting ducts. The addition of the anticholinergic agent oxybutynin aggravated the condition by causing a dry mouth with excessive thirst and water intake in our first case. Dietary water overconsumption, either voluntary or involuntary, is a phenomenon seen in formula-fed babies. But in our second case, a game involving forced ingestion of large amounts of water had serious consequences including hyponatremia-related coma. An effort should therefore be made to inform caretakers about the risks of these games. These cases, provoked by rather unusual and peculiar causes, illustrate again that electrolytes and especially serum [Na(+)] are key points to be determined in a child with diminished consciousness. Moreover, an accurate history including the intake of medication and dietary information should be made.

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Citations

Apr 27, 2013·Journal of Pediatric Urology·Barbara LucchiniMario G Bianchetti
May 28, 2014·Acta Paediatrica·Jakub Zieg
Nov 29, 2011·Annales d'endocrinologie·Marie-Christine VantyghemClaire Douillard
Mar 11, 2018·BMJ Case Reports·Ana Margarida MonteiroAna Antunes
May 16, 2017·International Journal of Legal Medicine·Jessica VanhaebostGregory Schmit
Jun 9, 2020·Paediatric Drugs·Elke GasthuysJohan Vande Walle

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