Correspondence

Organic Osmolytes in the Brain of an Infant with Hypernatremia

N Engl J Med 1994; 331:1776-1777December 29, 1994

Article

To the Editor:

The report by Lee et al. (Aug. 18 issue)1 leaves me curious. Partial holoprosencephaly was discovered on magnetic resonance imaging (MRI) in an 18-month-old girl who was severely dehydrated and “lethargic but otherwise normal.” Was this child's diagnosis known at the time of her admission for dehydration? Was the child, in fact, a neurologically normal 18-month-old?

Marjorie Schulman, M.D.
Bronx Municipal Hospital Center, Bronx, NY 10461

1 References

1. 1

   Lee JH, Arcinue E, Ross BD. Organic osmolytes in the brain of an infant with hypernatremia. N Engl J Med 1994;331:439-442
   Full Text | Web of Science | Medline

Author/Editor Response

The authors reply:

To the Editor: The diagnosis of partial holoprosencephaly was not known at the time of admission, but was discovered during the preliminary MRI performed as part of the magnetic resonance spectroscopic examination. Dr. Schulman correctly identifies an omission in our very compressed clinical history; the child had neurodevelopmental delay, was below the fifth percentile in her physical development. (Instead of “otherwise normal” we should have written “otherwise in her normal state of health.”) When the child was admitted an intracranial abnormality was suspected, because of the polyuria and hypodipsia, the absence of vomiting or diarrhea, the child's single upper incisor. Because inborn errors of metabolism that are present during neural development may result in anatomical abnormalities, we would like to highlight the advantage of performing MRI and magnetic resonance spectroscopy in young children presenting with severe electrolyte or other metabolic disturbances.

Jung Hee Lee, Ph.D.
Huntington Medical Research Institutes

Edgardo Arcinue, M.D.
Huntington Memorial Hospital

Brian D. Ross, M.D., Ph.D.
Huntington Medical Research Institutes, Pasadena, CA 91105

Citing Articles (1)

Citing Articles

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