Department of General Paediatrics and Endocrinology, Leicester Children's Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK.
UCL Department of Renal Medicine, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.
Acta Paediatr. 2024 Jan;113(1):150-154. doi: 10.1111/apa.16734. Epub 2023 Mar 10.
Hypernatraemia typically reflects dehydration, yet in rare instances may be caused by salt poisoning. Identifying these rare cases is a difficult challenge. Making the diagnosis of salt poisoning can have severe consequences, such as the removal of the child from its home or even prison sentences for the implicated carer. It is therefore imperative to get the diagnosis right. Guidelines for the assessment of hypernatraemia emphasise the importance of the fractional excretion of sodium to distinguish between dehydration and salt poisoning, but no generally accepted cut-off value exists. Opinions about the diagnosis of salt poisoning in some cases consequently may differ. Here, we aim to highlight the challenges and stimulate discussion on how to improve the tools for the assessment of hypernatraemia.
Report of a case of unexplained hypernatraemia in which the treating paediatrician raised the suspicion of salt poisoning.
Two consulted experts made opposing judgements about the aetiology of the observed hypernatraemia.
Clear diagnostic criteria for the diagnosis of salt poisoning are lacking and more data are needed for their establishment. Without this, victims may experience further harm and carers are at risk of devastating, yet potentially erroneous accusations.
高钠血症通常反映脱水，但在极少数情况下可能由盐中毒引起。识别这些罕见病例是一个具有挑战性的难题。做出盐中毒的诊断可能会产生严重后果，例如将孩子从家中带走，甚至对涉案照顾者判处监禁。因此，正确诊断至关重要。评估高钠血症的指南强调了钠排泄分数的重要性，以区分脱水和盐中毒，但目前尚无普遍接受的临界值。因此，对于某些情况下盐中毒的诊断意见可能存在差异。在这里，我们旨在强调这些挑战，并探讨如何改进评估高钠血症的工具。
报告一例不明原因的高钠血症病例，治疗的儿科医生怀疑盐中毒。
两位咨询专家对所观察到的高钠血症的病因做出了相反的判断。
缺乏盐中毒诊断的明确诊断标准，需要更多的数据来建立这些标准。没有这些标准，受害者可能会受到进一步的伤害，而照顾者则面临着可能错误的毁灭性指控的风险。
