What's Your Diagnosis? Pediatric Electrolyte Emergencies

Welcome to this month’s What’s Your Diagnosis Challenge!

But before we begin, check to see if you got last month’s case on Responsible and Safe Use of Opioids in Children and Adolescents in the Emergency Department right.

Case Presentation: Pediatric Electrolyte Emergencies: Recognition and Management in the Emergency Department

A 3-day-old girl is brought in by her father, with concern for shaking episodes…

The infant was born full-term and has been fed formula at home. The father has been mixing the formula himself and is unsure whether his measurements have been exact. The infant began vomiting today and is more lethargic, with intermittent jerking episodes. The girl’s vital signs are: temperature, 37°C; heart rate, 200 beats/min; blood pressure, 60/30 mm Hg; respiratory rate, 30 breaths/min; and oxygen saturation, 100% on room air. The child has a sunken anterior fontanelle. What workup should you initiate at this time?

Case Conclusion

You sent serum electrolyte studies, which showed severe hyponatremia (118 mEq/L). The girl was resuscitated with IV 3% hypertonic saline. She was admitted to the pediatric intensive care unit for continued sodium monitoring. Myelinolysis was prevented by not overcorrecting the sodium. After stabilization and during an opportune moment, you reviewed safe formula mixing with her father and provided support.