Management Challenges in a Child with Chronic Hyponatremia:
Chronic hyponatremia is very rare in children and is often seen in the setting of congestive heart failure or liver failure in adults. Here, we report an 8-year-old child with hypothalamic glioma who presented with severe hyponatremia. Initial management consisted of fluid restriction. This was very difficult for the child to follow and the child developed bizarre drinking habits requiring intervention from child psychiatry. So therapy was initiated with low dose V2 receptor antagonist under close inpatient monitoring. While initial response was reassuring, her sodium levels tended to drift down with longer duration of treatment requiring us to increase the dose frequently. Her response to therapy and her stable clinical situation off therapy suggest that she may have reset osmostat.

An 8-year-and-1-month old Caucasian female presented to her pediatrician with complaints of nocturnal enuresis and hyperactivity. Child was adopted at 2 years of age along with her younger sibling due to history of parental neglect by biological parents. Adoptive parents reported hyperactivity as a major concern. Physical examination revealed her weight to be 24.8?Kg (25th percentile for age) and height to be 128.7?cm (35th percentile for age). Vitals were stable and blood pressure at presentation was 113/75?mmHg. A comprehensive neurologic exam by her pediatrician revealed fine tremors in the upper extremity....