Central Pontine Myelinolysis in a Previously Healthy 4-Year-Old Child With Acute Rotavirus Gastroenteritis

CASE REPORT

A 4½-year-old previously healthy and developmentally normal right-handed boy presented to the emergency department of an outlying community hospital with a 3-day history of watery diarrhea and vomiting. He had no prior history of unusual gastrointestinal illnesses. According to his mother, he had been cooperative and able to follow complex commands. He had been given several promethazine suppositories as well as loperamide while at home with no resolution of his symptoms. His admission temperature was 100.3°F, and he appeared mildly dehydrated. Admission laboratory tests showed a serum sodium level of 136 mEq/L, and he was rehydrated with D₅½ normal saline (NS). Four hours into therapy, he became unresponsive with circumoral cyanosis. He was intubated, stabilized with mechanical ventilation, and sedated with lorazepam. Pertinent laboratory values at that time included a serum sodium of level 118 mEq/L. The treatment team began an infusion of NS and gave furosemide. Two hours later his sodium level was 128 mEq/L; 4 hours later it was 130 mEq/L. A chest radiograph showed bilateral diffuse infiltrates consistent …