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Journal of Pediatric Neurology 2021; 19(01): 040-042
DOI: 10.1055/s-0040-1708496
Case Report

Extremely Elevated Cerebrospinal Fluid Protein and Glucose Level in a Neonate with Hypernatremic Dehydration

Arti Maria
1   Department of Neonatology, Postgraduate Institute of Medical Education and Research & Dr. RML Hospital, New Delhi, India
,
Tapas Bandyopadhyay 
1   Department of Neonatology, Postgraduate Institute of Medical Education and Research & Dr. RML Hospital, New Delhi, India
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Abstract

We describe the case of a term newborn who presented with hypernatremic dehydration on day 19 of life. The baby was otherwise hemodynamically stable with no evidence of focal or asymmetric neurological signs. The laboratory tests at the time of admission were negative except for hypernatremia and the extremely elevated levels of cerebrospinal fluid (CSF) protein (717 mg/dL) and glucose levels (97 mg/dL). The hypernatremic dehydration was corrected as per the unit protocol over 48 hours. Repeat CSF analysis done after 5 days showed normalization of the protein and glucose levels. Serial follow-up and neuroimaging showed no evidence of neurological sequelae. Unique feature of our case is this is the first case reporting such an extreme elevation of CSF protein and glucose levels that have had no bearing on neurodevelopmental outcome at 1 month and 3 months of follow-up.

Keywords

hypernatremia - cerebrospinal fluid - extreme elevation


Publication History

Received: 09 December 2019

Accepted: 11 February 2020

Article published online:
31 March 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
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  • References

  • 1 Shaywitz BA. Extreme elevations of cerebrospinal fluid protein. Association with hypernatremic dehydration. Am J Dis Child 1970; 120 (01) 84-87
    CrossrefPubMedGoogle Scholar
  • 2 Josman N, Tee NWS, Maiwald M, Loo LH, Ho CKM. Pragmatic and evidence-based approach to paediatric cerebrospinal fluid reference limits for white cell count and concentrations of total protein and glucose. J Clin Pathol 2018; 71 (10) 932-935
    CrossrefPubMedGoogle Scholar
  • 3 Guillaumin J, DiBartola SP. A quick reference on hypernatremia. Vet Clin North Am Small Anim Pract 2017; 47 (02) 209-212
    CrossrefPubMedGoogle Scholar
  • 4 Rother KI, Schwenk II WF. An unusual case of the nonketotic hyperglycemic syndrome during childhood. Mayo Clin Proc 1995; 70 (01) 62-65
    CrossrefPubMedGoogle Scholar
  • 5 Lemelman MB, Letourneau L, Greeley SAW. Neonatal diabetes mellitus: an update on diagnosis and management. Clin Perinatol 2018; 45 (01) 41-59
    CrossrefPubMedGoogle Scholar
  • 6 Chisti MJ, Pietroni MA, Alom MS, Smith JH. Use of only oral rehydration salt solution for successful management of a young infant with serum sodium of 201 mmol/L in an urban diarrhoeal diseases hospital, Bangladesh. J Health Popul Nutr 2012; 30 (03) 371-376
    CrossrefPubMedGoogle Scholar
  • 7 Sabzehei MK, Afjeh SA, Shakiba M, Alizadeh P, Shamshiri AR, Esmaili F. Hyperglycemia in VLBW infants; incidence, risk factors and outcome. Arch Iran Med 2014; 17 (06) 429-434
    PubMedGoogle Scholar