Acute salt poisoning due to different oral rehydration solution (ORS) packet sizes

Quereshi, Umar A.; Bhat, Javeed I.; Ali, Syed Wajid; Mir, Abid Ali; Kambay, Altaf H.; Bhat, Imtiyaz Nawaz

doi:10.1007/s12098-010-0095-0

Cited by 13 publications

(9 citation statements)

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“…6 A significant association has been reported between high values of sodium in breast milk (range 17-88 mEq/L, normal value < 7 mEq/L) and development of hypernatremia in neonates with no risk factors and who are exclusively breastfed. 8 The high concentration of sodium in breast milk in neonates with hypernatremic dehydration with suspected hypoalimentation raises the question whether the greater enteral sodium intake is the cause of the whole clinical picture. 9 Many mechanisms might be responsible, such as high daily sodium intake associated with large free water losses.…”

Section: Discussionmentioning

confidence: 99%

Extreme Neonatal Hypernatremia and Acute Kidney Injury Associated with Failure of Lactation

Tomarelli¹,

Arriagada²,

Donoso³

et al. 2019

J Pediatr Intensive Care

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Hypoalimentation is an important cause of hypernatremic dehydration in neonates; however, extreme values of plasma sodium make it necessary to investigate the differential diagnosis. We report the case of a 20-day-old newborn who was admitted with severe hypernatremic dehydration, with plasma sodium of 213 mEq/L and oliguric acute renal failure. The patient was treated with intravenous fluids for correction of dehydration and peritoneal dialysis for adequate sodium correction. During the etiological study, a 10-fold increase in the concentration of sodium in breast milk was detected. Peritoneal dialysis was an effective therapy in the management of the extreme hypernatremia with sodium correction within the recommended rate. At the 1-year follow-up appointment, the child had normal renal function, normal for age psychomotor development, and neurological physical was unremarkable. In conclusion, we report a case of an unusual extreme hypernatremia with discussion of the underlying pathophysiology and, more importantly, the effective treatment with a mixed approach with intravenous fluids and peritoneal dialysis.

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Section: Discussionmentioning

confidence: 99%

Extreme Neonatal Hypernatremia and Acute Kidney Injury Associated with Failure of Lactation

Tomarelli¹,

Arriagada²,

Donoso³

et al. 2019

J Pediatr Intensive Care

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“…One concern is the confusion between 2 different sizes of ORS packets leading to preparation of standard ORS packet in 200 ml of water causing hypernatremic dehydration and on the other hand, dissolving the smaller packet in 1 litre of water increasing the risk of hyponatremia in children with diarrhea. 28 Unfortunately, most of the parents still do not have the correct information and knowledge regarding the proper preparation of ORS.…”

Section: % 44%mentioning

confidence: 99%

Study of electrolyte disturbances and renal parameters in acute gastroenteritis under 5 years of age in a tertiary care hospital of Bengaluru, India

Shankar

Mahamud

Aara

2020

Int J Contemp Pediatr

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Background: Diarrhoea still continues to be a major cause of hospitalization and death in under fives. Electrolyte disturbances play an important role in the associated morbidity and mortality. Acute renal failure is one of the important complications of acute gastroenteritis (AGE) in children. Early intervention and proper fluid replacement may lessen this risk. This study was designed to find out the incidence of acute gastroenteritis and the status of associated electrolyte derangements and renal involvement.Methods: This was a cross sectional study conducted at KIMS, Bengaluru in which 117 children from the age of 1 month to 5 years with acute diarrhea were included based on a predefined inclusion and exclusion criteria. Demographic profile of the patients, details of diarrhea, clinical examination and accompanying degree of dehydration (defined as per WHO criteria) were recorded. Serum electrolytes along with renal parameters were investigated.Results: Total 117 children with acute gastroenteritis were enrolled in the study as per the inclusion criteria which constituted 5% of total paediatric admissions. Children aged 1-12 months had the highest incidence of diarrhea (50%). Male to female ratio is 1.3:1. 65% had some dehydration, 19% no dehydration and 16% had severe dehydration. Isonatremia was seen in 58% followed by hyponatremia in 35% and hypernatremia in only 7%. 83% had isokalemia, hypokalemia in 12%, hyperkalemia in 5%. Levels of serum sodium and potassium decreased with the severity of dehydration. Serum urea and creatinine were significantly high in severe dehydration (p value 0.001). Out of 28 children who were given diluted ORS before admission, majority had hyponatremia (39%) and all of them who received concentrated ORS had hypernatremia.Conclusions: Hyponatremic dehydration is the second most common type of dehydration next to isonatremic dehydration, but it is more common in children who took diluted ORS. Increased awareness regarding ORS preparation may help in preventing electrolyte imbalance in AGE. The levels of serum sodium and potassium decreased and urea and creatinine increased with severity of dehydration. Measurements of serum electrolytes and renal parameters early can help to predict the complications due to AGE and may help in the prevention of diarrhea related complications in children.

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“…The common causes of hypernatraemia in children include dehydration from not drinking adequate amounts of water or continuous total body fluid losses from diarrhoea, persistent vomiting, renal losses or severe sepsis [1]. Central nervous system manifestations like lethargy, seizures and coma from brain haemorrhage usually occur at higher levels of serum sodium (> 160mmol/L) and can also occur without dehydration [2,3]. The neurological sequelae arising from neurological complications include seizure disorders, spastic plegias and intellectual deficits [3].…”

Section: Introductionmentioning

confidence: 99%

Symptomatic Hypernatraemia Secondary to Ingestion of Poorly Constituted Oral Rehydration Solution – A Case Report

Okechukwu

Briggs

2020

AJPR

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Aim: Hypernatremia is a recognized complication of poorly constituted Oral Rehydration Solution (ORS) use that can cause neurological manifestations which require careful but often challenging management to prevent morbidity and mortality. Herein we report a case of symptomatic hypernatremia in a 2-year-old boy following ingestion of poorly constituted Oral Rehydration Solution (ORS) and highlight challenges in management. Presentation of Case: This is a case report of a 2-year-old male who presented with a four-day history of vomiting and fever. He received four litres of hyper-concentrated ORS (1 packet of ORS to 0.7 l of water) prior to presentation. At presentation, he was lethargic and subsequently lapsed into unconsciousness. He also developed focal and generalized seizures. Serial serum electrolytes testing showed hypernatremia which ranged from 157-161 mmol/L in the first 48 hours of admission for which appropriate intravenous fluids were given. Serum sodium levels gradually returned to normal (140-142 mmol/L) with treatment. He subsequently regained full consciousness after four days in a coma and was discharged home in satisfactory clinical condition. Conclusion: This case is being reported to highlight the important role of proper history taking, careful fluid and electrolyte monitoring in the diagnosis and care of this condition and emphasise on adequate education of caregivers by clinicians and the mass media on appropriate preparation of ORS.

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Acute salt poisoning due to different oral rehydration solution (ORS) packet sizes

Cited by 13 publications

References 0 publications

Extreme Neonatal Hypernatremia and Acute Kidney Injury Associated with Failure of Lactation

Extreme Neonatal Hypernatremia and Acute Kidney Injury Associated with Failure of Lactation

Study of electrolyte disturbances and renal parameters in acute gastroenteritis under 5 years of age in a tertiary care hospital of Bengaluru, India

Symptomatic Hypernatraemia Secondary to Ingestion of Poorly Constituted Oral Rehydration Solution – A Case Report

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