One cause of hypernatremia in children is intentional administration as a form of Munchausen Syndrome by Proxy. The author is from St. James’s University Hospital in Leeds, England.



(1) hypernatremia

(2) elevated urine sodium concentration

(3) normal renal function

(4) normal endocrine evaluation

(5) no disease identified that can explain hypernatremia

(6) cessation of hypernatremia when separated from probable perpetrator(s)

(7) circumstantial evidence or confession for intentional salt administration


The child may present with:

(1) vomiting

(2) diarrhea

(3) failure to thrive

(4) abnormal neurological signs (rigidity, hyperreflexia, seizures, coma)


Unless comatose or vomiting, the child is usually very thirsty.


Differential diagnosis:

(1) accidental swallowing of salt tablets

(2) error in fluid administration, using a high salt concentration

(3) specimen or laboratory error


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