Academic journal article Journal of Health Population and Nutrition

Use of Only Oral Rehydration Salt Solution for Successful Management of a Young Infant with Serum Sodium of 201 mmol/L in an Urban Diarrhoeal Diseases Hospital, Bangladesh

Academic journal article Journal of Health Population and Nutrition

Use of Only Oral Rehydration Salt Solution for Successful Management of a Young Infant with Serum Sodium of 201 mmol/L in an Urban Diarrhoeal Diseases Hospital, Bangladesh

Article excerpt

INTRODUCTION

Hypernatraemia is a serious ramification of diarrhoea often associated with death (1). Death may occur either due to hypernatraemia itself or anytime during its correction. Hypernatraemia causes widespread cerebral haemorrhage, thromboses, and subdural effusions, leading to permanent neurologic deficit and death (2,3). On the other hand, improper and aggressive rehydration in patients with prolonged hyperosmolality has been shown to result in a rapid fall in extracellular fluid (ECF) osmolality, leading to cerebral oedema and death (4,5). Ideally, correction should result in a fall of serum sodium of around 10-12 mmol/L/24 hours, preventing cerebral oedema and convulsion (6,7). However, when hypernatraemia develops over a period of few hours, a rapid correction at a rate of 1.0 mmol/L/hour prevents the risk of cerebral oedema because accumulated electrolytes are rapidly extruded from the brain cells (8,9). The choice of fluid for the correction of hypernatraemic dehydration is very difficult. Among various schools of thought about the choice of fluids, ORS is preferred for a slow and gradual restoration of the deficit because oral or nasogastric (NG) rehydration using ORS is safe and associated with significant reduction in complications compared to intravenous rehydration (10,11). Correction of hypernatraemic dehydration using intravenous hypo- or hypertonic solution is often used in preventing a rapid fall of serum sodium and consequent cerebral oedema. However, there are no conclusive data on the efficacy of the use of either ORS or intravenous hypo- or hypertonic solution for the safe correction of hypernatraemic dehydration.

The Dhaka Hospital of icddr,b admits a large number of diarrhoeal patients, and a number of them also present with hypernatraemic dehydration. Most of the patients receive only ORS for the correction of hypernatraemic dehydration, irrespective of the level of serum sodium. A report of a patient whose serum sodium was 201 mmol/L and received only ORS for correction, is presented here.

CASE HISTORY

A boy aged 4 months 7 days from a middle-class family (monthly family-income of Tk 10,00015,000 equivalent to US dollar 121-181) living in Dhaka district was brought to the Dhaka Hospital of icddr,b on 9 January 2011 and admitted to the Short Stay Unit on the same day. Immediately after admission, he was shifted to the hospital's ICU for his respiratory distress and irritability. He had a history of watery diarrhoea for 3 days, associated with vomiting for the same duration, fever and respiratory distress for the last 12 hours. His stool frequency was 12 times/day, vomiting 2 times/day, and fever was high and continued but not associated with chills and rigours, and respiratory distress was not associated with cough. The child had passed urine half-an-hour before admission in the ICU. He received 6 packets (3 litre) of inappropriately-prepared (concentrated) ORS at home but no drugs. History of his past illness was unremarkable. He did not have a history of contact with any persons known or suspected to have tuberculosis, and his family members were in good health. He was the second and the last issue of his non-consanguineous parents and was delivered normally at home at full term. His weight and height at birth could not be obtained. He was breastfed at birth, and it continued up to 2 months. Since then, he was given mixed-milk (formula milk and breastmilk). His developmental milestones were age-appropriate, and his vaccinations were up-to-date according to the local EPI (Expanded Programme on Immunization) schedule. Both the parents were literate (education of the father and the mother was up to college and high school level respectively); the father was a garments worker, and the mother was a housewife. They were living in a tinshed house, used to drink tubewell water but their sanitation was poor.

On admission, the infant was initially irritable and excessively thirsty but he became very lethargic soon after admission. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.