Water Intoxication in a Cretinoid Infant1

Abstract

A 4-month-old myxedematous infant in a state of coma is presented. Subnormal temperatures, coma, convulsions and shock were the main clinical findings. The examination of the serum electrolytes disclosed a profound hyponatremia and hypochloremia with a normokalemia. This complication of myxedema had been precipitated by gavaging and overloading the patient with fluids. Hypervolemic hyponatremia (water intoxication) resulted, most probably due to inappropriate antidiuretic hormone secretion, as suggested by Goldberg and Reivich (26). The hazards of overloading myxedematous patients with fluids is stressed, since in reviewing the literature on myxedema coma it seems likely that some of these cases were actually myxedematous patients with iatrogenic water intoxication.