Severe Hyponatraemia and Klebsiella pneumoniae Meningitis in a Severely Malnourished Infant: A Case Report

Abstract

Severe hyponatremia with seizures in infancy is an uncommon but life-threatening condition, especially when complicating severe acute malnutrition (SAM) and central nervous system infection. Klebsiella pneumoniae meningitis, rare beyond the neonatal period, is associated with high morbidity and mortality. This report highlights multifactorial causes of infantile seizures and the need for thorough evaluation and targeted management. A 4-month-old male infant with background perinatal hypoxic–ischemic encephalopathy presented with recurrent seizures, fever, and poor feeding. He had global hypertonia and non-oedematous SAM. Laboratory tests showed profound hyponatremia (serum sodium 110 mmol/L), hypocalcaemia, anaemia, and marked thrombocytosis. Cerebrospinal fluid analysis showed hypoglycorrhachia and growth of K. pneumoniae. He received culture-guided antibiotics for 21 days, nutritional rehabilitation, and careful sodium supplementation via feeds, thereby raising serum sodium to 131 mmol/L over 4 days, with seizure control and weight gain. Early electrolyte monitoring, correction of dyselectrolytaemia, and rational antibiotic therapy are vital therapeutic steps when a nervous system infection coexists with severe acute malnutrition in resource-limited settings.