A Case of Hyponatremia-induced Seizures in an Infant Secondary to Water Intoxication from the Use of Almond Milk

Abstract

Pediatric seizures are a common presentation to the emergency department. It is important to separate non-febrile seizures from febrile seizures, as non-febrile seizures have a much broader differential diagnosis. For infants less than six months of age with a normal exam, hyponatremia is the leading cause of new onset non-febrile seizure. Most commonly, this is secondary to water intoxication from inappropriate feeding practices. This case report will review the initial workup of new onset non-febrile seizures in an infant and treatment recommendations for seizures secondary to hyponatremia.

Infantile Status Epilepticus: A Case of Excessive Water Intake in a Five-Month-Old Girl

“…Hyponatremia is the main factor in new-onset non-febrile seizures in infants younger than six months of age with a normal exam; this mostly occurs as a result of improper feeding practices that result in water intoxication [ 2 ]. In this case, the infant had been receiving an excessive amount of water in between frequent formula feedings, which led to hyponatremia.…”

“…Status epilepticus secondary to water intoxication is a rare condition in infancy, which is characterized by somnolence or irritability, followed by seizures, and is associated with hyponatremia [ 1 ]. Water intoxication typically manifests clinically as nausea, vomiting, altered mental status, edema, hypothermia, and seizures [ 2 ]. Pathophysiologically speaking, slow correction at a rate of less than 0.5 mmol/L/hour is preferable in both acute and chronic hyponatremia.…”

“…A rapid correction of severe hyponatremia can lead to complications in the brain, especially in the central pontine and extrapontine myelinolysis [ 1 , 3 , 4 ]. The prognosis has varied in the cases that have been described, from total recovery to permanent debilitation [ 2 ].…”

Physician and Parent Perceptions on Plant-Based Beverages as Substitutes for Cow’s Milk: A Single City Survey

“…Pediatric cases of metabolic alkalosis, hematuria, dysuria, kidney stones and hyperoxaluria were associated with excessive almond beverage ingestion (8). Hyponatremia-induced seizures secondary to water intoxication and a case of scurvy from almond beverage use have been reported (9,10). A paper by Vittorio outlines several cases of adverse events occurring in pediatric patients from indiscriminate use of plant-based beverages (11).…”

Symptomatic hypercalcemia in an infant secondary to excessive consumption of almond milk as a formula alternative

“…Although more than 30 cases of nutrition‐related diseases have been reported for plant‐based milk alternatives, 2–4 the use of almond milk has been underreported. Almond milk can be associated with hyponatremia‐induced nonfebrile seizures, increased risk for kidney stone formation, and scurvy 5–7 . Almond milk is often fortified with calcium and can contain more than six times as much calcium as breast milk, but only half the phosphorus content 8,9 .…”