Elevation of the serum sodium concentration has been recognized as a frequent phenomenon in the fluid and electrolyte imbalances accompanying infant diarrhea.* Its importance is indicated by the fact that the mortality rate in such cases is five times that of patients with normal or low sodium concentration.2 Recognition of the disturbance is more difficult than the diarrheal imbalances in which salt depletion is prominent. Marked disturbances of the central nervous system occur. Fluid and electrolyte management during repair is difficult.
Our experience with patients with diarrhea and hypernatremia has led us to conclude that two mechanisms, singly or together, are the causes of the disturbance. These are (a) profound water depletion with hyperosmolarity of which the hypernatremia is a part and (b) sodium administration in excess of the excretory capacity of the kidney.
This report will present the clinical problem as manifested in a number of patients, and