Status seizures as a secondary effect from the “squash drinking syndrome” in an infant

TL;DR

An infant had a seizure due to excessive consumption of hypotonic drinks, leading to severe low sodium levels.

Contribution

Highlights status seizures as a new complication of squash drinking syndrome in infants.

Findings

Severe hyponatremia (118 mmol/L) caused a status seizure in an 11-month-old due to squash drinking syndrome.

Seizures resolved when sodium levels increased to 123 mmol/L with hypertonic saline.

Excessive hypotonic drink intake can lead to neurological and growth complications in infants.

Abstract

The “hypotonic drink syndrome” is characterized by loss of appetite, normal activity levels and, in some cases, intestinal disturbances in children with an intake of more than 30% of the recommended daily calories in the form of non‐dairy drinks. Diarrhea and growth retardation are possible complications due to the amount of nonnutritive calorie intake (“empty calories”) contained in this type of hypotonic beverages.

We present the case of an 11‐month‐old boy who suffered a “Squash drinking syndrome” requiring admission to the pediatric intensive care unit because of a status seizure secondary to a severe hyponatremia (118 mmol/L) due to massive ingestion of hypotonic drinks, such as squash. The seizure did not subside until sodium levels reached 123 mmol/L with hypertonic saline (3%). Neurological, renal, digestive, endocrine and metabolic problems were all ruled out and normal sodium levels were maintained with dietary recommendations and a restriction of hypotonic fluid intake.

To prevent these situations it is important to be aware of this entity and to know how to identify the possible complications that may appear after excessive ingestion of hypotonic drinks, as in the case of our patient, ranging from lack of appetite, growth failure and diarrhea, to a status seizure.