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According to the Merck Manual, (25) clinical manifestations are primarily in the neurological system (because of an osmotic shift of water into brain cells causing edema while the skull sets an upper limit on the amount of allowable swelling, unlike the skin of an extremity; therefore, the brain is the organ most sensitive to changes in sodium), especially in acute hyponatremia, and include headache, confusion, and stupor, seizures, and coma.
We report a case of rapidly developing iatrogenic acute hyponatremia in a child after an improper hypotonic fluid infusion to compensate for inadequate fluid intake secondary to post-tonsillectomy pain and difficulty swallowing.
In addition, the rapid correction of acute hyponatremia can induce central potine myelinolysis, which emphasizes the importance of preventing hyponatremia (Hassan, Kruer, & Fuhrman, 2007).
Hospital-acquired acute hyponatremia and reports of pediatric deaths
In acute hyponatremia the most important risk to address is cerebral edema, because brain cells have too little time to adapt to cell swelling.

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