Seizures during correction of hypernatremic dehydration in an infant.

This 16-day-old breast-fed infant had a three-day history of poor feeding and increasing somnolence. She was the 3.6-kg product of an uncomplicated first pregnancy. Fever, emesis, and diarrhea were denied. Examination revealed a lethargic, emaciated, and severely dehydrated baby who weighed 2.3 kg. Dextrostix blood glucose was 20 mg/dL. Normal saline (15 mL/kg), DsoW (1 mL/kg), and DIO 0.45% saline at 50 mL/h were administered. The infant was transferred to the hospital. On arrival, the baby was afebrile with a pulse of 180 beats per minute and a BP of 45/20 mmHg. Treatment included intravenous volume expansion with -0.9% saline and colloid until vital signs and central venous pressure were normal, followed by D2.5 0.2 % saline plus 50 mEq NaHC03/L at a rate calculated to replace fluid deficits over 48 hours. Eight hours after admission, peritoneal dialysis with a 1.5% dextrose, 160 mEql L sodium solution was initiated because of anuria and progressive azotemia. Four hours later the infant became increasingly lethargic. Generalized seizures developed and recurred over the next 24 hours, despite appropriate anticonvulsant therapy. Computed tomography (CT) of the brain suggested cerebral edema. Pertinent laboratory information is summarized in Table 2. The hypernatremia was corrected after 96 hours. After resolution of the hyperosmolar state, there were no further seizures. Results of repeat neurological examination, EEG, and CT scan of the head were normal before discharge from the hospital.