Severe hyponatremia due to water intoxication in a child with sickle cell disease: A case report
https://doi.org/10.4081/ecj.2022.10364
Accepted: 12 April 2022
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Water intoxication is a potentially fatal hypo-osmolar syndrome with brain function impairment. Isolated symptomatic excessive ingestion of free water is very rare in childhood. We report a case of acute hyponatremia due to water intoxication without Antidiuretic Hormone (ADH) excess in a child with sickle cell disease. The boy was admitted to our Emergency Department because of new-onset prolonged generalized seizures. Blood test showed hyponatremia, and elevated creatine kinase value; neuroimaging was negative. His recent medical history revealed that on the day before he had drunk about 4 liters of water in 2 hours to prevent sickling, because of back pain. He was treated with mild i.v. hydration with normal saline solution and showed progressive clinical improvement and normalization of laboratory test. Rhabdomyolysis is a rare complication of hyponatremia whose underlying mechanism is still unclear.
Zieg J. Evaluation and management of hyponatraemia in children. Acta Pædiatr 2014;103:1027-34. DOI: https://doi.org/10.1111/apa.12705
Rangan GK, Dorani N, Zhang MM, et al. Clinical characteristics and outcomes of hyponatremia associated with oral water intake in adults: a systematic review. BMJ Open 2021;11:e046539. DOI: https://doi.org/10.1136/bmjopen-2020-046539
Gardner JW. Death by water intoxication. Mil Med 2002;167:432-4. DOI: https://doi.org/10.1093/milmed/167.5.432
Lee LC, Noronha M. When plenty is too much: water intoxication in a patient with a simple urinary tract infection. BMJ Case Rep 2016;bcr2016216882. DOI: https://doi.org/10.1136/bcr-2016-216882
Yamashiro M, Hasegawa H, Matsuda A, et al. A case of water intoxication with prolonged hyponatremia caused by excessive water drinking and secondary SIADH. Case Rep Nephrol Urol 2013;3:147-52. DOI: https://doi.org/10.1159/000357667
Boetzkes S, Van Hoeck K, Verbrugghe W, et al. Two unusual pediatric cases of dilutional hyponatremia. Pediatr Emerg Care 2010;26:503-5. DOI: https://doi.org/10.1097/PEC.0b013e3181e5bf9e
Bruce RC, Kliegman RM. Hyponatremic seizure secondary to oral water intoxication in infancy: association with commercial bottled drinking water. Pediatrics 1997;100:E4. DOI: https://doi.org/10.1542/peds.100.6.e4
Radojevic Bjelogrlic B, Aleksic V, Rancic N, et al. Forensic aspects of water intoxication: Four case reports and review of relevant literature. Forensic Sci Int 2012;220:1-5. DOI: https://doi.org/10.1016/j.forsciint.2012.01.021
Barber GA, Withefield JS. Cultivated Child Abuse. A 2-Year-Old With Hyponatremic Seizures. Pediatr Emerg Care 2012;28:1234-5. DOI: https://doi.org/10.1097/PEC.0b013e318272089d
Tuli G, Tessaris D, Einaudi S, et al. Copeptin role in polyuria-polydipsia syndrome differential diagnosis and reference range in paediatric age. Clin Endocrinol (Oxf) 2018;88:873-9. DOI: https://doi.org/10.1111/cen.13583
Christ-Crain M, Refardt J, Winzeler B. Approach to the patient: “Utility of the copeptin assay”. J Clin Endocrinol Metab 2022; online ahead of print. Doi: 10.1210/clinem/dgac070. DOI: https://doi.org/10.1210/clinem/dgac070
Christ-Crain M, Fenske WK. Copeptin in the differential diagnosis of hypotonic polyuria. J Endocrinol Invest 2020;43:21-30. DOI: https://doi.org/10.1007/s40618-019-01087-6
Morita S, Inokuchi S, Yamamoto R, et al. Risk factors for rhabdomyolysis in self-induced water intoxication (SIWI) patients. J Emerg Med 2010;38:293-6. DOI: https://doi.org/10.1016/j.jemermed.2007.09.040
Warren JD, Blumbergs PC, Thompson PD. Rhabdomyolysis: a review. Muscle Nerve 2002;25:332-47. DOI: https://doi.org/10.1002/mus.10053
Porter M. Rapid fire: sickle cell disease. Emerg Med Clin North Am 2018;36:567-76. DOI: https://doi.org/10.1016/j.emc.2018.04.002
Okomo U, Meremikwu MM. Fluid replacement therapy for acute episodes of pain in people with sickle cell disease. Cochrane Database Sist Rev 2017;7:CD005406. DOI: https://doi.org/10.1002/14651858.CD005406.pub5
Vande Walle J, Stockner M, Raes A, Norgaard JP. Desmopressin 30 years in clinical use: a safety review. Curr Drug Saf 2007;2:232-8. DOI: https://doi.org/10.2174/157488607781668891
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Downloads
Citations
