title: Fatal Hyponatremic Encephalopathy as a Result of Child Abuse From Forced Exercise.
abstract: We report a case of fatal hyponatremic encephalopathy in a child who was forced to exercise as a form of punishment. A 9-year-old girl with attention-deficit/hyperactivity disorder was forced to run repeated 50-ft sprints to the point of exhaustion by her grandmother as punishment for taking candy from a classmate. After more than 3 hours of forced running, the child collapsed, began to vomit, and had repeated clonic seizures. Upon presentation to the emergency department, she was nonresponsive with a Glasgow Coma Scale score of 11 and had noncardiogenic pulmonary edema with serum sodium of 117 mEq/L. She was treated with antiepilectic medications and transferred to a university children's hospital where she later died. On postmortem examination, she was found to have massive cerebral edema with transtentorial herniation and pulmonary edema. Her clinical presentation closely resembled exercise-associated hyponatremic encephalopathy seen in adult endurance athletes. This appears to be the first report of fatal exercise-associated hyponatremia in a child.
authors.affiliation: From the *Division of Nephrology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA and †Forensic pathologist Montgomery.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Moritz
authors.forename: James R
authors.initials: JR
authors.lastname: Lauridson
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity; D001927:Brain Diseases / Q000209:etiology*; D001929:Brain Edema; D002648:Child; D002649:Child Abuse; D015444:Exercise; D017809:Fatal Outcome; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007010:Hyponatremia / Q000209:etiology*; D011654:Pulmonary Edema; D011678:Punishment; D012420:Running; D012640:Seizures; D012964:Sodium / Q000097:blood; D014839:Vomiting
chemical_list: D012964:Sodium