Two children with unobstructed total anomalous pulmonary venous drainage and hyperkinetic pulmonary hypertension deteriorated with pulmonary oedema and cerebral symptoms following angiocardiography using large amounts of contrast medium. One patient died. The dangers of this with resultant hypernatraemia are discussed.

Hypernatraemia in very low birth weight babies has been well documented and is usually attributable to excessive insensible water loss. We report a case in which, despite a peak serum sodium concentration of 204 mmol/l, the baby survived without morbidity. Treatment was simply to increase the intake of free water in Dextrose.

1. Van Biesen W, Lameire N, Vanholder R. Why less success of the peritoneal dialysis programmes in Europe? Nephrol Dial Transplant 2008; 23: 1478–1481 2. Mehrotra R, March D, Vonesh E et al. Patient education and access of ESRD patients to renal replacement therapies beyond in-center hemodialysis. Kidney Int 2005; 68: 378–390 3. Khawar O, Kalantar-Zadeh K, Lo WK et al. Is the declining use of l...

As internists we like to think of ourselves as physicians with knowledge of disturbances of the milieu intérieur. Indeed, other specialities often call us for help when they are confronted with fluid and electrolyte disorders. The unrivalled number one of your electrolyte consults will undoubtedly be hyponatraemia. For example, hyponatraemia may arise in the postoperative period due to the comb...

Emery, J. L., Swift, P. G. F., and Worthy, E. (1974). Archives of Disease in Childhood, 49, 686. Hypernatraemia and uraemia in unexpected death in infancy. The electrolyte concentration of the vitreous humour of the eye in a consecutive series of 40 infants dying unexpectedly at home was measured. In 25 of these infants no morbid anatomical cause of death was found, but in half of these infants...