Case 8

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A 4-week-old baby presents with seizures and signs of hypernatremic dehydration. A serum sodium level is 159. A urine sodium test was sent to the laboratory. The teenage mother lives alone with her first child. She states that she has been preparing the formula correctly. She reports that the baby frequently vomits after feeds. The mom has brought her to the primary care physician six times for complaints of vomiting since birth.

If the urine sodium is elevated, which of the following is most likely true?

A. The baby has been fed hypertonic fluids and the mother should be reported immediately to child protective services for suspicion of medical child abuse.

B. The baby has a renal problem.

C. The baby has been fed hypertonic fluids and a further dietary history is needed.

D. The symptoms of vomiting were most likely fabricated.