Hyponatraemic seizure in a 6-month-old infant due to water intoxication

Informing Infant Nutrition: Timing of Infant Formula Advice, Infant Formula Choice and Preparation in the First 6 Months of Life

OBJECTIVE

To examine the sources and timing of advice formula feeding parents receive and how this and other factors influence the choice of formula product and formula preparation.

DESIGN

Components of a cross-sectional survey.

SETTING

A child and family health service in New South Wales, Australia.

PARTICIPANTS

Parents (n = 153) who were fully or partially formula feeding infants aged 0-6 months and who visited the service's facilities or its social media site.

VARIABLES MEASURED

Type of formula, preparation of formula, and use and sources of formula feeding advice.

ANALYSIS

Descriptive statistics, Mann-Whitney U or Pearson's chi-square tests, and inductive content analysis.

RESULTS

The most common source of formula feeding advice was the formula tin/packet (96.6%). Although 79.2% received advice from a health professional, only 18.9% reported receiving this advice before using formula. Approximately half (48.0%) of the parents chose a standard cow's milk-based formula. The most common reason for their choice of formula type/brand was a personal recommendation (53.0%). Parents' responses indicated that nearly half (46.3%) incorrectly prepared the formula.

CONCLUSION AND IMPLICATIONS

Although health professional advice was widely received, this was rarely before starting formula. Despite the current national infant feeding regulations, parents who were not exclusively breastfeeding their infants did not always receive timely, health professional advice about formula feeding.

Severe hyponatremia in children: a review of the literature through instructive cases

Hyponatriemia is the most common electrolyte disorder in the paediatric population. Symptoms are related to the time in which hyponatriemia has developed. The acute presentation could be dramatic, with neurological symptoms like headache, seizure, impaired mental status and even coma. It is essential for the physician to be aware of the possible causes of hyponatremia in the child in order to start a prompt treatment.

Desmopressin acetate-induced water intoxication in a dog with psychogenic polydipsia

A 21-month-old male Border Collie presented to emergency service after a generalised tonic–clonic seizure. He received desmopressin acetate (1-Desamino-8-D-Arginin-Vasopressin, DDAVP) intraconjunctivally and intranasally for treatment of suspected central diabetes insipidus (DI) for a year, but water intake had recently increased again to 120–150 ml/kg/day. History, physical examination and clinicopathological findings, especially marked hyponatraemia, were consistent with water intoxication. The condition was stabilised by discontinuation of DDAVP and fluid restriction. Hyponatraemia resolved with frequent adjustments of fluid management according to physical parameters and electrolyte status. After exclusion of other causes for polyuria and polydipsia (PD), a modified water deprivation test led to diagnosis of psychogenic PD. Long-term outcome was excellent with water restriction and intensified dog training.

A 27-Month-Old Boy with Polyuria and Polydipsia

Psychogenic polydipsia is a well-described phenomenon in those with a diagnosed psychiatric disorder such as schizophrenia and anxiety disorders. Primary polydipsia is differentiated from psychogenic polydipsia by the lack of a clear psychotic disturbance. We present a case of a 27-month-old boy who presented with polyuria and polydipsia. Laboratory studies, imaging, and an observed water deprivation test were consistent with primary polydipsia. Polydipsia resolved after family limited his fluid intake and began replacing water drinking with other transition objects and behaviors for self-soothing. This case highlights the importance of water deprivation testing to differentiate between causes of polyuria, thereby avoiding misdiagnosis and iatrogenic hyponatremia. Secondly, primary polydipsia can result during the normal stages of child development without overt psychiatric disturbances.