Hypernatremic hemorrhagic encephalopathy as an unexpected critical complication in children: a case report from a tertiary hospital
- pdf |
- DOI: https://doi.org/10.15562/ism.v14i1.1667 |
- Published: 2023-04-01
Open Access & Peer Reviewed
Multidisciplinary Journal of Science and
Medical Research
Multidisciplinary Journal of Science and
Medical Research
Abstract
Introduction: Hypernatremic hemorrhagic encephalopathy (HHE) is one of the complications of hypernatremic dehydration which is relatively uncommon in patients with hypernatremia. Severe hypernatremia might lead to brain shrinkage resulting in intracranial bleeding which can increase morbidity and mortality, especially in children. Hypernatremic hemorrhagic encephalopathy is harmful, but only limited cases are reported. This case highlights the role of cautious management of hypernatremic dehydration and the need for intense monitoring due to the unexpected complication of HHE.
Case presentation: A 4 months old female infant presented with a decreased consciousness. She showed signs of shock along with acute diarrhoea and severe dehydration. Laboratory findings revealed severe hypernatremia and high septic marker. Rehydration and correction of hypernatremia were done, but during the process, several episodes of general tonic-clonic seizure occurred. A Head CT scan was done and showed subdural hemorrhage in the posterior interhemispheric fissure and intraventricular hemorrhage in the posterior horn of the right lateral ventricle. Conservative management was undertaken and the patient was clinically improved progressively. On the 11th day of hospitalization, the patient's condition had been significantly improved without neurological sequelae and was later discharged on the 11th day of hospitalization.
Conclusion: Close monitoring of clinical, neurological, and laboratory examination is essential in the management of hypernatremic dehydration due to the possibility of HHE, even when on the right procedure. Once neurological complication is suspected, an immediate imaging study should be performed and modifying therapy is required.
References
- Turakhia S, Jyoti G. Two Rare Cases of Hypernatremic Haemorrhagic Encephalopathy in Children. BJKines-NJBAS. 2016;8(2):55.
- Das CJ. Hypernatremic dehydration in newborn infants. Ulutas Med J. 2015;1(2):22-25.
- Elamin A, Nair P. Hypernatremic Dehydration in Infancy. Paediatrics. 2007;8:161-170.
- Moritz ML, Ayus JC. Preventing neurological complications from dysnatremias in children. PEdiatr Nephrol. 2005;20:1687-1700.
- Leung C, Chang WC, Yeh SJ. Hypernatremic dehydration due to concentrated infant formula: report of two cases. Pediatr Neonatol. 2009;50(2):70-73.
- Hariram T, Naido KL, Ramji S. Hypernatremic dehydration in infants with acute gastroenteritis at King Edward VIII Hospital. South African Journal of Child Health. 2018;12(1):10-14.
- Sultana A, Hanif M, Nazir M, Parvin R, Sadia N, Nahid KL. Frequency, clinical presentation, and immediate outcome of hypernatremic dehydration in children with acute diarrhea. Bangladesh J Child Health. 2015;39(1):18-23.
- Parwata W, Hartawan I, Suwarba I, Suparyatha I, Wati D. Perbedaan pemberian cairan isotonis dan hipotonis terhadap osmolalitas plasma pada penderita gangguan intrakranial akut di RSUP Sanglah, Denpasar, Bali. Intisari Sains Medis. 2019;10(1).
How to Cite
Saunders, R., Suparyatha, I. B. G. ., Wati, D. K. ., Hartawan, I. N. B. ., & Satyarsa, A. B. S. . (2023). Hypernatremic hemorrhagic encephalopathy as an unexpected critical complication in children: a case report from a tertiary hospital. Intisari Sains Medis, 14(1), 290–293. https://doi.org/10.15562/ism.v14i1.1667
