Cultivated child abuse: A 2-year-old with hyponatremic seizures

摘要

Hyponatremia leading to seizures is well described in children. Hyponatremia is defined as a serum sodium of less than 135 mEq/L and can be acute or chronic. The seizure threshold in hyponatremia is markedly increased at a level of 125 mEq/L or less. Hyponatremia is one of the most common electrolyte disturbances and occurs in both the inpatient and outpatient setting. The 3 types of hyponatremia are hypovolemic, euvolemic, and hypervolemic. The diagnosis is made through serologic and urinary laboratory studies. We present the case of a 2-year-old girl with recurrent hyponatremic seizures, who was resuscitated twice within a short period at our institution. Her hyponatremia coupled with the seizures was initially thought to be secondary to salt-wasting renal disease, adrenal insufficiency, or even syndrome of inappropriate antidiuretic hormone secretion. The case took an interesting twist, which led us to conclude that this was an uncommon yet not unheard of form of child abuse.