Severe Unexpected Hyponatremia in an Infant With Cystic Fibrosis Carriership
Bibliographic record
Abstract
This report describes the development of severe hyponatremia in a 4-month-old infant, with known carriership of cystic fibrosis (CF; heterozygous delta F508 cystic fibrosis transmembrane conductance regulator (CFTR) mutation), in the course of a coronavirus disease 2019 (COVID-19) infection with mild respiratory symptoms and a urinary tract infection. Laboratory investigations were performed in the outpatient clinic because of persistent loss of appetite, fussiness and mild weight loss after a recent antibiotically treated urinary tract infection. The results showed severe hyponatremia of 115 mmol/L, mild hypokalemia of 3.0 mmol/L, with normal renal function, without other biochemical signs of dehydration and neither signs of fluid retention. Urinary fractional sodium excretion was extremely low, indicative of adequate renal sodium retention in the hyponatremic state. We hypothesize that the combination of disturbed extrarenal salt losses due to CF carriership, together with loss of appetite, relatively low sodium content of breastmilk and possibly COVID-19-associated mild syndrome of inappropriate antidiuretic hormone secretion (SIADH), resulted in the severe hyponatremia that was found in this infant. We believe it is important to report the findings in the current case to underscore the intricate balance of sodium homeostasis in the fully breastfed older infant and the alertness for checking sodium levels during infections/illness in heterozygote CF patients, as was previously reported in literature. In conclusion, this report describes the development of severe unexpected hyponatremia in the course of a mild infectious period in a fully breastfed 4-month-old infant with known CF carriership and underscores the importance of measuring sodium levels with low threshold during infections in CF carriers. Int J Clin Pediatr. 2023;12(2):45-50 doi: https://doi.org/10.14740/ijcp516
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".