Extreme hyponatraemia with intact neurological outcome in a young child with Addison's disease.
The authors present the case of a 6-year-old boy with a good neurological outcome from extreme hyponatraemia caused by autoimmune hypoadrenalism. He presented with 1 week of reduced appetite, lethargy, vomiting and one episode of diarrhoea. He was described as being slightly unsteady on his feet. Clinically he was alert, although intermittently confused, with dry mucous membranes and sunken eyes. Serum sodium was 96 mmol/l with normal serum potassium and renal function. He was initially treated with 3% saline intravenously, and his serum sodium increased to 128 mmol/l by day 3. He developed slurred speech and ataxia on day 4, although MRI brain showed no evidence of pontine myelinosis, and the symptoms resolved over 1 week. A Synacthen test on day 10 confirmed a diagnosis of Addison's disease and he was commenced on hydrocortisone and fludrocortisone replacement therapy. At 5 months follow-up there are no obvious neurological or developmental sequelae.
Department of Child Health, North Devon District Hospital, Barnstaple, UK. jposmith@gmail.com
John-Paul
JP
Smith
Christine
C
Burren
Yonas
Y
Cherinet
D000224:Addison Disease / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002648:Child; D003937:Diagnosis, Differential; D005438:Fludrocortisone / Q000627:therapeutic use; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D007010:Hyponatremia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008297:Male
D000893:Anti-Inflammatory Agents; D005438:Fludrocortisone; D006854:Hydrocortisone