Abstract
We present the first reported case of severe salt poisoning in an extremely low birth weight neonate. The salt poisoning was managed with the careful use of intravenous fluids, insulin to manage the severe hyperglycemia, and furosemide to induce a saline diuresis. The hypertonicity was normalized slowly over 3 days by following the corrected serum sodium (Na) (serum Na+2.7 mEq for every 100 mg/dl of glucose over 100). No neurological damage was seen in our patient during the development of the hypertonicity or its correction. This suggests that the premature brain can develop osmoprotective molecules if hypertonicity develops slowly over 2–3 days. Slow correction is therefore recommended to avoid the development of water intoxication during correction. Despite the development of mild reversible renal failure, a large saline diuresis was induced with furosemide, thereby avoiding the need for dialysis in our patient. The only complication was the development of necrotizing enterocolitis, which has not been previously reported in association with salt poisoning.
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Avery ME, Mandell J, Simmons C, Harmon W, First LR (1989) Nephrology. In: Avery ME, First LR (eds) Pediatric medicine. Williams and Wilkins, Baltimore, p 605
Robson AM (1992) Parental fluid therapy: isolated disturbances in concentrations of electrolytes. In: Behrman RE, Kliegman RM, Nelson WE, Vaughan VC III (eds) Nelson textbook of pediatrics, 14th edn. Saunders, Philadelphia, p 210
Fine RN (1990) Peritoneal dialysis. In: Gellis SS, Kagan BM (eds) Current pediatric therapy, 13th edn. Saunders, Philadelphia p 358
Finberg L (1993) Therapeutic management of hypernatremic dehydration. In: Finberg L, Kravath RE, Hellerstein S (eds) Water and electrolytes in pediatrics, 2nd edn. Saunders, Philadelphia, pp 148–153
Rose BD (1989) Hyperosmolal states — hypernatremia. In: Rose BD (ed) Clinical physiology of acid-base and electrolyte disorders, 3rd edn. McGraw-Hill, New York, p 669
Sterns RH, Spital A (1990) Disorders of water balance. In: Kokko JP, Tannen RL (eds) Fluid and electrolytes, 2nd edn. Saunders, Philadelphia, p 669
Conley SB (1990) Hypernatremia. In: Arnold WC, Kallen RJ (eds) Pediatric clinics of North America — fluid and electrolyte therapy. Saunders, Philadelphia, pp 365–372
Finberg L, Kiley J, Luttrell CN (1963) Mass accidental salt poisoning in infancy. JAMA 184:187–190
Miller NL, Finberg L (1960) Peritoneal dialysis for salt poisoning. N Engl J Med 263:1347–1350
Finberg L (1973) Hypernatremic (hypertonic) dehydration in infants. N Engl J Med 289:196–198
Barer J, Hill LL, Hill RM (1973) Fatal poisoning from salt used as an emetic. Am J Dis Child 125:889–890
Saunders N, Balfe JW, Laski B (1976) Severe salt poisoning in an infant. J Pediatr 88:258–261
Harris GD, Fiordalisi I, Finberg L (1988) Safe management of diabetic ketoacidemia. J Pediatr 113:65–68
Finberg L (1993) Hypernatremic dehydration. In: Finberg L, Kravath RE, Hellerstein S (eds) Water and electrolytes in pediatrics, 2nd edn. Saunders, Philadelphia, pp 124–134
Moder KG, Hurley DL (1990) Fatal hypernatremia from exogenous salt intake: report of a case and review of the literature. Mayo Clin Proc 65:1587–1594
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Roscelli, J.D., Yu, C.E. & Southgate, W.M. Management of salt poisoning in an extremely low birth weight infant. Pediatr Nephrol 8, 172–174 (1994). https://doi.org/10.1007/BF00865471
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DOI: https://doi.org/10.1007/BF00865471