title: Extreme hypernatremic dehydration due to potential sodium intoxication: consequences and management for an infant with diarrhea at an urban intensive care unit in Bangladesh: a case report.
abstract: BACKGROUND
  Hypernatremia (serum sodium ≥ 150 mmol/L) is one of the most life-threatening complications of childhood diarrhea, and its management remains challenging, even in a highly advanced critical care setting. This case report describes the acute clinical course and 3-month neurological follow-up after discharge of an infant with extreme hypernatremia in an intensive care unit in Dhaka, Bangladesh.
  
  
  METHODS
  A 6-month-old Asian Bangladeshi girl of middle-class socioeconomic status was admitted to the intensive care unit of our institution in 2012 with acute watery diarrhea, lethargy and hypernatremia (208 mmol/L serum sodium). She had a history of taking excess oral rehydration salt: five packets each, inappropriately prepared, rice-based, properly diluted, glucose-based oral rehydration salt. Her hypernatremia was treated exclusively with oral rehydration salt solution. She experienced seizures on the third day of her hospitalization and was treated with anticonvulsant drugs. Later in the course of her hospitalization, Enterobacter spp bacteremia was detected and successfully treated with ciprofloxacin. Although magnetic resonance imaging of her brain at discharge showed cerebral edema, brain magnetic resonance imaging appeared normal at a follow-up examination 3 months after discharge. Electroencephalograms taken at discharge and at her 3-month follow-up examination also appeared normal.
  
  
  CONCLUSIONS
  Successful management of extreme hypernatremia with only oral rehydration salt did not result in observable neurological consequences, which emphasizes the importance of the use of oral rehydration salt for the clinical management of childhood hypernatremia.
authors.affiliation: Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. sumon@icddrb.org.|School of Public Health, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Herston Road, Herston, QLD, 4006, Australia. sumon@icddrb.org.
authors.forename: Sumon Kumar
authors.initials: SK
authors.lastname: Das
authors.affiliation: Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. farzanaafroz@icddrb.org.|Clinical Service Centre, icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. farzanaafroz@icddrb.org.
authors.forename: Farzana
authors.initials: F
authors.lastname: Afroze
authors.affiliation: Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. tahmeed@icddrb.org.
authors.forename: Tahmeed
authors.initials: T
authors.lastname: Ahmed
authors.affiliation: Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. gfaruque@icddrb.org.
authors.forename: Abu Syed Golam
authors.initials: AS
authors.lastname: Faruque
authors.affiliation: Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. sasarker@icddrb.org.|Clinical Service Centre, icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. sasarker@icddrb.org.
authors.forename: Shafiqul Alam
authors.initials: SA
authors.lastname: Sarker
authors.affiliation: Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. sayeeda@icddrb.org.|Clinical Service Centre, icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. sayeeda@icddrb.org.
authors.forename: Sayeeda
authors.initials: S
authors.lastname: Huq
authors.affiliation: Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. mislam@icddrb.org.|Clinical Service Centre, icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. mislam@icddrb.org.
authors.forename: M Munirul
authors.initials: MM
authors.lastname: Islam
authors.affiliation: Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. lubabashahrin@icddrb.org.|Clinical Service Centre, icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. lubabashahrin@icddrb.org.
authors.forename: Lubaba
authors.initials: L
authors.lastname: Shahrin
authors.affiliation: Clinical Service Centre, icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. fariha@icddrb.org.
authors.forename: Fariha Bushra
authors.initials: FB
authors.lastname: Matin
authors.affiliation: Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. chisti@icddrb.org.|Clinical Service Centre, icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. chisti@icddrb.org.
authors.forename: Mohammod Jobayer
authors.initials: MJ
authors.lastname: Chisti
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use; D001459:Bangladesh; D001639:Bicarbonates / Q000627:therapeutic use; D003681:Dehydration / Q000150:complications*; D003968:Diarrhea, Infantile / Q000150:complications*; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects; D005947:Glucose / Q000627:therapeutic use; D006801:Humans; D006955:Hypernatremia / Q000209:etiology / Q000628:therapy*; D007223:Infant; D007362:Intensive Care Units; D011189:Potassium Chloride / Q000627:therapeutic use; D012640:Seizures / Q000188:drug therapy / Q000209:etiology; D012964:Sodium / Q000008:administration & dosage / Q000009:adverse effects*; D012965:Sodium Chloride / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D001639:Bicarbonates; C044142:World Health Organization oral rehydration solution; D012965:Sodium Chloride; D011189:Potassium Chloride; D012964:Sodium; D005947:Glucose