Hyponatremia — an Unusual Presentation of Respiratory Syncytial Virus Infection

Respiratory syncytial virus (RSV) bronchiolitis is the most common cause of admission to the pediatric ward and Pediatric Intensive Care Unit (PICU) for respiratory distress and respiratory failure in infancy. There has been an increasing emphasis on the importance of extra pulmonary manifestations of RSV infection that include hyponatremia, hepatitis, seizures, arrhythmias, and cardiorespiratory failure. Physicians should consider this diagnosis in all newborns especially the preterm infants born after 35 weeks of gestation, and who do not qualify for the monoclonal antibody (Palivizumab) prophylaxis against RSV. Such patients can deteriorate rapidly, if extra pulmonary manifestations of RSV infection are not recognized and managed in a timely fashion. We report a case of RSV Bronchiolitis in a 32 days old preterm infant (ex-35 weeker) who presented with hypoglycemia, hyponatremia, respiratory failure and shock of unknown etiology.