Case report of hypotonic dehydration with outcome in cerebral edema in a child

Abstract

Dehydration is one of the most common disorders of water and electrolyte metabolism in young children. The reasons leading to the lack of water in the child’s body are very diverse. In clinical practice, a correct assessment of the pathophysiological mechanisms in various types of dehydration is necessary, which will allow timely identification of changes in various organ systems and conduct rational rehydration therapy. Water losses in children occur in a certain sequence. First of all, the intravascular subsector of the extracellular sector is subjected to water losses (clinical manifestations of dehydration in the child in this case are absent). If the pathological process continues, the intercellular subsector of the extracellular sector loses water, and then the patient first presents clinical symptoms: loss of body weight, dryness and brightness of the mucous membranes, reduction of subcutaneous fiber turgor, shrinkage of the mole in children of the first year of life, reduction of diuresis. Last of all, the intracellular sector loses its volume. Depending on the osmolarity of the extracellular fluid, isotonic, hypertonic and hypotonic dehydration are isolated. The most difficult in children is hypotonic dehydration, which is accompanied by a low osmolarity of the extracellular sector with predominant losses of sodium from the body. A retrospective analysis of a clinical case illustrates water-electrolyte disturbances in hypotonic dehydration. The child developed extracellular hypotonic dehydration because of sodium and water loss through the gastrointestinal tract. Hypotonic dehydration is characterized by an extreme degree of dissonance of the water-electrolyte balance, that is, the patient has severe extracellular dehydration and intracellular hyperhydration (edema, cell swelling). In this clinical case, violations of the waterelectrolyte balance led to the development of cerebral edema against the background of the existing cerebral deficiency, and death.