An Infant With Extreme Hypernatremia Treated With Peritoneal Dialysis

Reports of survival of infants with serum sodium levels exceeding 200 mmol/L are extremely rare. We describe a 34-day-old, 3.6-kg male infant who developed extreme hypernatremia (serum sodium >200 mmol/L) and multiple organ dysfunction syndrome following accidental salt poisoning. When continuous renal replacement therapy (CRRT) was not feasible because of the patient’s low body weight and lack of appropriately sized equipment, peritoneal dialysis (PD) was initiated as rescue therapy. Within 24 hours, serum sodium decreased to 186.7 mmol/L, with parallel improvements in metabolic acidosis, coagulopathy, and other organ functions. PD was discontinued on day 7, and the infant was discharged with normal neurological and organ function. This case supports PD as a life-saving option for extreme hypernatremia in low body weight infants when CRRT is unavailable.