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

Abstract

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.