Oral Water Intoxication in Infants

Keating, James P.; Schears, Gregory J.; Dodge, Philip R.

doi:10.1001/archpedi.1991.02160090037018

Cited by 98 publications

(37 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Poverty, care giver inexperience, lack of proper instruction by health care providers, or a combination of these factors has been implicated in virtually all reported cases. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] These associations characterize the patients in our series as well. Some have identified an association of infantile water intoxication with families receiving infant formula through the WIC.…”

Section: Discussionmentioning

confidence: 92%

“…[1][2][3][4][5][6][7][12][13][14][15][16][17] Symptoms are preceded by a rapid fall in serum sodium concentration to Յ125 mEq/L and result from an acute overload of solute-free water substantial enough to increase total body water by 7% to 8% or more. 22 Reported time intervals over which infants have been fed water in excess sufficient to precipitate hyponatremic seizures have varied from 90 minutes to 48 hours.…”

Section: Discussionmentioning

confidence: 99%

“…22 Reported time intervals over which infants have been fed water in excess sufficient to precipitate hyponatremic seizures have varied from 90 minutes to 48 hours. 1,14 The subsequent rapid fall in serum sodium concentration is thought to result in physiologic dysfunction at the neuron level, which in turn leads to varying degrees of clinical neurologic dysfunction. 23 Twelve of the infants in our series underwent cranial computed tomographic imaging, 8 of whom had acute hyponatremia.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][13][14][15][16][17][18] A wide range of ingested volumes of water and times over which the ingestion occurred has been reported. [1][2][3][4][5][6][7][8][13][14][15][16][17] The accuracy of dietary histories, often a nebulous combination of chronic as well as acute ingestions in the same patient, is confounded additionally by retrospective analysis. Although adequate neurologic homeostasis can be maintained in chronically hyponatremic patients, such infants may be especially prone to developing symptomatic hyponatremia after a relatively small increment in total body water.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Hyponatremic Seizures Secondary to Oral Water Intoxication in Infancy: Association With Commercial Bottled Drinking Water

Bruce

Kliegman

1997

Pediatrics

View full text Add to dashboard Cite

ABSTRACT. In recent years, hyponatremic seizures resulting from water intoxication have been reported in the United States with an increasing frequency that some have likened to an epidemic.1 Infants of parents living in poverty and uninformed of the risks of feeding fluids other than infant formula to their babies are particularly at risk.1-12 Young infants with vomiting and diarrhea are especially prone to developing hyponatremia if fed fluids lacking sufficient sodium, but even those who are otherwise well may develop symptomatic hyponatremia as a result of being fed excess solute-free water. Most often tap water, either in the form of supplemental feedings or overly dilute formula, has been given in excessive amounts over relatively short periods of time.1-11,13-16 Less frequently, water in other forms such as juice, soda, or tea has been implicated. 12,16 -19 This report includes the cases of two infants treated at our institution for hyponatremic seizures and water intoxication after being fed with the same bottled drinking water product marketed for use in infants. The medical records of all infants <1 year of age admitted to our institution over 10 years with the diagnosis of hyponatremic seizures were also reviewed. CASE REPORTS Case 1On October 7, 1993, a 55-day-old African-American infant was brought to the emergency department at a local hospital for evaluation of new onset "eye twitching." En route to the hospital, she began to have generalized tonic-clonic seizure. Her rectal temperature was 35.6°C; heart rate, 180; and blood pressure, 90/50 mm Hg. Pupils were equal and reactive, and funduscopic examination was normal. Edema was noted in the periorbital and gluteal regions. All four extremities were moving rhythmically, and deep tendon reflexes were symmetrically hyperactive. Capillary refill time was Ͻ2 seconds, and the infant was acyanotic. Weight was 4.77 kg (50%); length, 52.0 cm (10%); and occipitofrontal circumference, 36.0 cm (10%).Laboratory analysis revealed serum sodium of 116 mEq/L; chloride 85, mEq/L; potassium, 5.6 mEq/L; bicarbonate, 16 mEq/0; glucose, 151 mg/dL (8.4 mmol/L); total calcium, 8.2 mg/dL (2.1 mmol/L); phosphate, 6.2 mg/dL (2.0 mmol/L); creatinine, 0.4 mg/dL (35.4 mmol/L); and blood urea nitrogen, 7 mg/dL (2.5 mmol/L). Blood gas analysis showed metabolic acidosis with base excess Ϫ4.5 mEq/L. After Ͼ45 minutes of seizure activity, treatment with lorazepam (0.13 mg/kg), phenytoin (20 mg/kg), and phenobarbital (20 mg/kg) provided control of seizures but resulted in respiratory depression. Urine output exceeded 6 mL/kg/h over the next 8 hours and was accompanied by a weight loss of 180 g and resolution of edema. With intravenous administration of 0.9% saline at a rate of 100 mL/kg/day, the serum sodium concentration returned to 138 mEq/L within 20 hours (a rate of 1.0 mEq/h); the metabolic acidosis also resolved. Clinical improvement within 24 hours was accompanied by a weight loss of 350 g. The infant was discharged in good condition, on formula feedings, after a 5-day hosp...

show abstract

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Hyponatremic Seizures Secondary to Oral Water Intoxication in Infancy: Association With Commercial Bottled Drinking Water

Bruce

Kliegman

1997

Pediatrics

View full text Add to dashboard Cite

show abstract

“…Precaution of a high fluid intake may be indicated in patients with cardiovascular disorders, pronounced chronic renal failure, low serum albumin levels or endocrinopathies (eg inappropriate ADH secretion). Rapid infusion of high amounts of hypotonic solutions in infants with hypertonic dehydration, criminally forced high oral fluid intake or near drowning in toddlers, or uncontrolled high intake of fluids in marathon runners or psychiatric patients may result in acute water intoxication and even in death (Keating et al, 1991;Speedy et al, 1999).…”

mentioning

confidence: 99%