Hyponatremia and Central Pontine Myelinolysis

What is hyponatremia? Information regarding CPM and EPM.

Savannah Hardin: Murder or Medical Malpractice

Let me start by saying, Savannah’s death is a tragedy, and I pray for her family and her friends. I hope this post might help shed light upon what caused her death.

A friend of mine posted comments regarding a blog she read about a 9 year old girl who was run to death by her grandmother (Joyce Garrard) and step mother (Jessica Hardin). When I read the title, I reacted immediately like I’m sure everybody did. I believed that these abusive people needed to pay for their crime,  then I read further.

The girl was forced to run for three hours because she had eaten a candy bar! Wow, this was definitely abusive. After running for three hours, she apparently went into a seizure. At this point, the step mother (who was 9 months pregnant) and paternal grandmother called 911.

This happened on a Friday afternoon and evening, and the girl died on the following Monday while in the hospital.

The autopsy revealed that she was dehydrated and had low sodium at the time of her death.

The report also stated that Savannah had a medical condition that involved her urinary system that required her to have monthly doctor’s visits. Apparently, eating chocolate could cause her serious complications which provoked the paternal grandmother into punishing her with running.

The step mother and  grandmother are being charged with murder. The grandmother is being charged with capital murder, so if she is convicted, she will face the death penalty.

Most of the information I’ve cited comes from the following article:

http://news.yahoo.com/2-charged-death-ala-girl-forced-run-082216169.html

My question is: what really happened to Savannah Hardin?

I have very limited information regarding her personal story, but I have a lot of information regarding hyponatremia. (Please see all of my posts regarding hyponatremia to find out more about this very common metabolic condition, and its life threatening consequences).

I really believe that her death was caused by or contributed to by medical malpractice or at the very least lack of appropriate medical care.

When I read the article regarding Savannah, so many questions come to mind. Did the women give the child water while she ran?

It is commonly believed that a person can exercise for long periods of time if they are provided water. (This is the case with many school athletic programs who push children to the extreme every year as long as they provide water breaks every 20 minutes.

Most people don’t realize how dangerous water is when exercising. When a person sweats, they release large amounts of salt through their sweat. If they proceed to drink large amounts of water, this will further dilute their blood sodium levels. It is so dangerous.

If Savannah’s guardians provided her water instead of an electrolyte based refreshment, like Gatorade, then this could have caused her sodium levels to drop dangerously low.

To further complicate her condition, Savannah had a urinary disorder/disease. Depending on what type of disease she had, this might have contributed to her ability to develop low sodium.

The basic symptoms of  severe dehydration and hyponatremia are the same: headache, nausea, vomiting, muscle cramps, seizures, dizziness, delirium and unconsciousness. Some of these symptoms may occur or all of these symptoms may occur. A big differentiation regarding those with dehydration is that they stop sweating.

Dehydration rarely causes seizures though, so I believe that when Savannah experienced seizures after running, it was because she was hyponatremic not dehydrated. It would be extremely difficult to determine without reviewing all of her medical records and questioning her family.

If her family was providing her with water, in combination with her physical condition and intense exercise, this would have been the perfect storm leading to her developing hyponatremia.

Why do I think there could have been medical malpractice?

It has been recognized that the standard treatment at the time of hospitalization for dehydration is IV fluids. These fluids tend to not contain sodium at all. If a person is treated with these nonsaline fluids and they actually have hyponatremia, then this treatment can be fatal.

It dilutes already diluted blood sodium levels. This would cause brain stem and cerebral swelling, further seizures, coma and brain death.

By the time the hospital receives the lab work showing low blood sodium levels, it is already too late to change the IV fluids to a low sodium based fluid, especially in children.

Please read the following information regarding the susceptibility of children for hyponatremia and how it is supposed that it is being caused mostly by hospital malpractice:

 It has now become apparent that the majority of hospital-acquired hyponatremia in children is iatrogenic and due in large part to the administration of hypotonic fluids to patients with elevated arginine vasopressin levels. Recent prospective studies have demonstrated that administration of 0.9% sodium chloride in maintenance fluids can prevent the development of hyponatremia. Risk factors, such as hypoxia and central nervous system (CNS) involvement, have been identified for the development of hyponatremic encephalopathy, which can lead to neurologic injury at mildly hyponatremic values. It has also become apparent that both children and adult patients are dying from symptomatic hyponatremia due to inadequate therapy. We have proposed the use of intermittent intravenous bolus therapy with 3% sodium chloride, 2 cc/kg with a maximum of 100 cc, to rapidly reverse CNS symptoms and at the same time avoid the possibility of overcorrection of hyponatremia.

This same research paper also recognizes that most children that develop it are inflicted by an underlying urinary condition:

 In order for hyponatremia to develop, there must typically be a relative excess of free water in conjunction with an underlying condition that impairs the kidney’s ability to excrete free water (see Table 2). Excretion of free water will be impaired when there is either (1) a marked reduction in glomerular filtration rate, (2) renal hypoperfusion, or (3) arginine vasopressin (AVP) excess. Most cases of hyponatremia are the result of increased AVP production.

The paper discusses what I mentioned above regarding how the symptoms for the cerebral edema in relation to hyponatremia can easily be diagnosed as other conditions, such as dehydration:

Hyponatremic encephalopathy can be difficult to recognize, as the presenting symptoms are variable and can be nonspecific (see Table 3). The only universal presenting features of hyponatremic encephalopathy are headache, nausea, vomiting, and lethargy. These symptoms can easily be overlooked, as they occur in a variety of conditions. There must be a high index of suspicion for diagnosing hyponatremic encephalopathy, as the progression from mild to advanced symptoms can be abrupt and does not follow a consistent progression.

The information that is quoted above comes from:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874061/

Now, here’s the take home message from the above article: if your child is being treated for ANYTHING in the hospital be sure they receive  .9% saline IV fluids.

I believe the hospital will be determined at least partially responsible for Savannah’s death. If the hospital had treated her for hyponatremia instead of dehydration in the beginning, Savannah might still be alive, and the reason I believe that they did not treat her for hyponatremia was because her autopsy showed that she was hyponatremic after being in the hospital for three days.  The media also implied that she was hospitalized for dehydration.

Please do not mistake that I condone the punishment the girl received: I DON’T. I really believe her punishment was harsh, but I am almost positive that her grandmother and step mother did not intend to cause her death, and I further believe that having the girl run that long did not DIRECTLY cause her death. It was a series of unfortunate events complicated by common ignorance, a medical condition, and the hospital incorrectly treating Savnnah for dehydration instead of hyponatremia.

 I hope that over the next few weeks or  months, more information becomes available so that people will better understand what happened to her.

We live in a democratic society, in which a person is presumed innocent until proven guilty. In our country, this has changed. We now get our information from the press, and we are quick to become the jury and the judge in such cases. I wonder if it will be a matter of time before we regress to a time where we will prosecute a person without a trial. This seems especially true in cases that involve children.

Who needs a judge or a jury, we have the press!

It is easy for me to sit back and criticize people for this type of reaction, but I am the same way. I read a story about a woman who microwaved her baby to death while in a drugged stupor, and my first reaction is that woman deserves to die a horrific death.

However, I refuse to read what the press publishes and believe that it is the whole story.

I may have several ideas as to what happened to Savannah, but it’s based on my very limited information. In order to know exactly what happened to her, a person needs to know: how long she ran; if she was provided fluids and what kind while she ran; what the treatment was that she received when she was transported in the ambulance and at the hospital; did the hospital recognize that she was hyponatremic and/or how long did it take for them to figure it out; what type of medical condition did she have and what was her urine osmolity?

If you are reading this, I pray that you pass this information along. It’s important that people know and understand the dangers involved with hyponatremia, especially regarding children. The more people realize the threat, the more pressure there is on a hospital to change their procedures for dehydration, and the fewer the number of children who will die or be forever brain damaged from hyponatremia.

UPDATE: According to news sources like the Huffington Post and ABC news, Jessica Hardin (Savannah’s Step-mother) is in the process of working out a deal with the prosecutors. Hopefully, the charges will be reduced, or her bail will be dropped to $500,000.

I do believe that there was a medical condition that caused Savannah to suffer from hyponatremia and that led to her death. I am hopeful that the charges will be dropped completely if it was, but unfortunately, innocence comes with a price.

http://www.cbsnews.com/8301-504083_162-57517645-504083/jessica-mae-hardin-ala-stepmom-accused-of-savannah-hardins-running-death-seeks-lower-bond/

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15 thoughts on “Savannah Hardin: Murder or Medical Malpractice

  1. what can we do ?

    • That’s an absolutely fantastic question!

      In regards to Samantha Hardin’s case, I highly recommend sharing my blog. I don’t have all the answers, but I think it’s important to give more insight than what’s being provided through the media, so sharing it with your family and friends or in places where you see such negative comments, I think is really important.

      In regards to what to do if your child is faced with a similar situation (get’s tremendously sick after participating in sports and strenuous activities), push Gatorade (or other sports drink that provides electrolytes including sodium), not water.

      If your child is sick to the point that they are being taken to the hospital, be absolutely CERTAIN they start an IV with .9% sodium OR if it’s possible (your child is not at critical risk) that they get their complete metabolic panel returned before any fluids are started. This way you know that whether the child is hyponatremic or dehydrated.

      The point of my blog is to try to educate people to the dangers of hyponatremia, and if you ask, almost no one has ever heard about it. I think by spreading the word regarding the dangers, risk factors, etc, we can prevent people from dying or being injured for the rest of their lives.

      But most importantly, Katie, ask questions and get answers. Once you have information that you believe is important, share it.

      Thank you for reading my blog!! And even more, thank you for asking questions! 🙂

      • something is wrong .i know joyce and jessice and i know very strongly joyce would never hurt savannah . something is wrong here . she did not run savannah .

      • Hi, Katie.

        Thanks for getting back with me. I also believe that there has been a lot of negative attention on Savannah’s death.

        I don’t have all the answers, so I can only make judgments on what information I do have, and I really don’t think enough information has been provided to make any conclusive decisions.

        I think because the topic could be sensationalized enough to sell newspapers and spawn public outcry, the negative aspects of the story have been exploited and spread.

        However, my opinion is purely my opinion based on the limited information that I have access to.

        I do believe there is more to the story than a grandmother, with any intent, forced her granddaughter to run until she died. I just don’t think it is true. If that was the case, there would be some hint of neglect or abuse previously, and from the information that I’ve seen, this isn’t the case.

        Anyway, I’m not a MD. Before I suffered from hyponatremia and the subsequent brain injury, I was preparing to enter into medical school or at the very least become a nurse practitioner.

        My goals have been postponed at least temporarily as I try to regain my cognitive abilities.

        I hope this helps you. I am hoping to get more information regarding Savannah’s case as it becomes available, and I did send a letter to Jessica’s and Joyce’s lawyer. He seemed interested in this possibility and was going to research it further. I really believe that all aspects of the situation need to be reviewed.

        God Bless!

  2. did you go to medical school? how long ? hey thank, not many people have anything good to say . in my heart i know they are innocent. thanks god bless.

  3. thank you! for understanding ever I do’nt understand what has happen but I do know what my heart tells me . I HAVE ALOT OF MEDICAL PROBLEMS AND I HAVE DEHYDRATION ALL THE TIME . COULD THIS BE SOMETHING THAT WOULD PASS ON TO MY CHILDERN OR OTHER FAMILY? I THANK ABOUT THAT; I THANK YOU FOR YOUR HELP AND YOU ARE NOT JUDGMENTAL.I LOVED SAVANNAH SHE WAS SO SWEET ‘ SHE WAS LIKE ALL KIDS . AND I LOVE ALL KIDS . I JUST WISHED EVERYONE KNEW HOW MUCH JOYCE LOVED HER. AND I UNDERSTAND WHY PEOPLE FELLS THE WAY THEY DO . I DO’NT BELIEVE IN CHILD ABUSE. I WILL NOT TAKE UP FOR ANY ONE WHO HURTS A CHILD .GOD BLESS YOU ! THANKS

    • Hi Katie.

      You’re welcome. I really hope that we get all the answers.

      I would ask your doctor regarding whether the cause for your chronic dehydration is a genetic condition. If there is a genetic cause, your children could develop it.

      Keep in mind that dehydration and hyponatremia are not the same thing. However, dehydration can cause serious illness, so it should not be ignored.

      Regarding Savannah, I’m sorry for your loss. It’s hard to lose someone you care for and to see your friends and family go through such a difficult time.

      I really believe that we can prevent more people from perishing from hyponatremia by spreading the word about it.

      Have a great night!

      • I know she was given water while she ran.

      • Hi, LP.

        If she was given water, not gatorade or another sports electrolyte based drink, this along with her urinary condition could have caused her to develop hyponatremia. I really think based on the information that’s been available so far, this is what happened.

        I really hope this becomes more of an awareness campaign to teach people how dangerous drinking water during strenuous activities can be, especially in children.
        Thanks for the input.

  4. kelley on said:

    the autopsy did not show no urinary condition an they also tote firewood while she ran if they had any idea she was sick why would they punish her like this my child is a diabetic its my job to teach her what she can and cannot eat what happens if she eats wrong thing not run her for three hours

    • Hi, Kelley.

      Those are great questions. I don’t agree with what Joyce did, however, I don’t believe she intentionally killed Savannah.

      The punishment that she gave was extreme and abusive, but was it murder? I don’t think it was. With murder, you have to have intent, and I don’t think she had the intent to kill her granddaughter.

      The autopsy wouldn’t reveal the urinary condition that Savannah had because it was an ongoing condition. The autopsy records current causes of death. It doesn’t state ongoing health issues a person has in their life.

      It was stated in the divorce records that were published online that Savannah received weekly care for a urinary condition.

      Another source stated this: “The defense contends that the women did absolutely nothing to cause Savannah’s death, which they blamed on a mystery medical problem. Previous court documents show the girl did have some health issues and made frequent visits to doctors.” Cited from: http://www.opposingviews.com/i/society/crime/capital-murder-charge-grandma-ran-savannah-hardin-death

      I don’t have enough information to determine whether the urinary issue she had caused her hyponatremia, but I really do believe it was a contributing factor to her death.

      There will be no way to know for sure until after the trial and all of the information is available to the public.

      I hope that helps.

  5. Teresa Osborn on said:

    I do agree with your medical statements, (I’m a nurse BSN) BUT..there is more than just a problem,As you must know there would have been signs and symptoms that should have been seen and reconginzed as a problem even to the untrained eye, before the actual seizure happened. Like – Nausea and vomiting; Headache; Confusion; Loss of energy; Fatigue; Restlessness and irritability; Muscle weakness or cramps…THEN seizures, and or unconsciousness, coma, death….so YES THEY COMMITTED A CRIME or they are not mentally competent. AVery tormenting thing to happen to someone, they do NOT..just seizure out.!!!! to get to that point is a process…one that was ignored that day. WHY? WHat were they thinking…She was faking it all???
    Due to the ABUSIVE ACTS OR NEGECT OF ACTING that facilitated the end result the minimum they should get is Manslaughter.IF I were to be the one prosecuting this , I would go for 2nd dgree and settle for manslaughter. 2nd degree Murder -non-premeditated killing, resulting from an assault in which death of the victim was a distinct possibility.Manslaughter – The essential distinction between the two offenses is that malice aforethought must be present for murder, whereas it must be absent for manslaughter. . The main difference between the two is that voluntary manslaughter requires an intent to kill or cause serious bodily harm while involuntary manslaughter does not. THere are actually several different types of manslaughter, (voluntary, involuntary,un-lawful act, crimanally neglect), Not knowing all the details it is presumptious to state for sure what is what, Although, as stated before…due to the facilitating circumstances…THERE was a crime committed by the TWO adults that should have been the ones to protect her. What is the exact title of the crime ???. The punishment…regardless…will never justify the death of the innocent little girl.

    • Hi, Theresa.

      Thank you for your comments.

      I want to emphasize a few points. The reason I created my blog is to spread the word about hyponatremia. It is common, very common, even among children, BUT the common person does not know or understand that much about it.

      I have a bit of medical knowledge and when I developed hyponatremia I DID NOT KNOW anything about it!

      One of my first symptoms was cramping in my feet. It wasn’t cramping that wouldn’t go away or anything that shouted out there’s something majorly wrong.

      My next symptom was a headache, but I had just had surgery, so I wasn’t concerned about it.

      The next symptom was nausea and lethargy. It was when I just could not stay awake that I asked to be taken to the ER, but I still didn’t go: Oh, my God I have hyponatremia.

      So, what’s my point?

      I do have medical knowledge, and I missed it.(Which is why I created my post on Savannah. To me her situation, is an absolute example of how careful we need to be in the treatment of our children.) The symptoms you mentioned above are common symptoms for hundreds of different illnesses from flu to meningitis, and in most cases it wouldn’t warrant a trip to the ER. AND that’s if she EVEN had all of those symptoms.

      I had a sodium level of 110, and I never lost consciousness, never threw up, never had delirium, etc. In other words, just because a person has low sodium doesn’t mean they’ll have all of the symptoms that you cited above.

      A child’s brain has less amount of room to swell, which means that Savannah could have easily gone from feeling sick to having seizures. If you take some time to read the research article that’s attached to my post, it describes how common major brain injury is in children who develop hyponatremia, and how seizure is one of the major symptoms in children who develop it.

      Regarding the legal aspects of the case, it’s not in my expertise to judge these women or what they did. That’s why we have a legal system, but I believe there is FAR more information regarding this case than what’s been published in the press,and we as the public need to leave the law to the law and to those who do have all the information.

      I am going to STRESS my position once more. My soul purpose in making my post is to bring awareness regarding hyponatremia and how common it is. It is a GROWING problem in our nation, in the world, and for reasons that I do not understand. There needs to be awareness in the public and updates to the way it’s treated in the hospitals.

      Further there needs to be additional instruction in our schools athletic programs. I have supported my son every year since elementary school to participate in football. EVERY YEAR there are reports of kids who DIE in the conditioning camps. THEY RUN FOR HOURS in SWELTERING HEAT. The coaches push these kids to drink WATER every 15 to 20 minutes. They believe it’s the heat and dehydration that kills them, and I now believe that it’s hyponatremia that might be responsible.

      I’ve pushed my son to drink WATER, and I never realized, even after going through physiology courses how dangerous this can be.

      Savannah Hardin died after developing hyponatremia (no matter how she developed it), and I have to wonder if her life would have been saved if she received proper treatment and care from the hospital and/or her guardians.

      Thank you for reading my post, and I hope you will aide in spreading the word about the threat of hyponatremia in our society.

  6. amieres on said:

    This is a great blog!
    I agree with the need to raise awareness on hyponatremia. There is so little information out there about it and most people simply don’t know and can’t even believe that too much water can kill you. The media tends to focus entirely on dehydration and .in doing so promote drinking fluids without clarifying that water alone can be dangerous.

    When I read about Savannah’s case I immediately suspected hyponatremia. My theory is that she was given too much water and when she developed symptoms the mother and grandmother forced her to drink even more water making it worse and that’s when seizures started.

    I myself am susceptible to hyponatremia because I sweat much more than the average person and I’m an avid tennis player, I can easily lose 10 pounds of sweat by playing 3+ hours in the summer. In fact I became aware of hyponatremia one day when I was preparing before a match against a tough opponent in the middle of summer. I started drinking as much water as I could because I wanted to be as hydrated as possible. When the match started a strange thing happened, I was lethargic, I felt as if I had already been playing for hours even though the match was just starting. The symptoms were similar to dehydration but I knew it couldn’t be. So I investigated in the internet and that’s how I found out about hyponatremia.

    Now when I play tennis I always prepare my jug of water with salt. I combine 5 grams of salt with 1 gallon of water, that is a close to the concentration of sweat. This has helped me enormously, I don’t get cramps anymore which was a normal occurrence before and I have much more energy during the match. Also after tennis I now eat something solid and salty and then I drink water but at a slow pace to let my organism adjust and regain the proper balance.

    • Thank You, Amieres for your response!

      I am glad you were not injured significantly when you began to develop hyponatremia. It is so dangerous, and so many people don’t realize how drinking large amounts of water can kill you, especially during intense activities.

      I was a nanny for two doctors. Their children participated in soccer, and they pushed water continuously, before during and after games and practices. That’s why I pushed my son to drink water before, during and after football. Until last year, I had no idea how dangerous it could be.

      I learned from my significant other, who is 12yrs older than me, that people used to have salt pills. You could find them in pharmacies, and when it was too hot outside or people were going to be active they would take these salt pills.

      It’s hard to find these salt pills now, and people are taught not to add salt to their diets. Granted we are getting a LOT of salt from processed foods, but I don’t know if it’s the right type of salt. Plus, those people who tend to be physically fit are also diet conscious, so I think it’s still important to teach people how to manage their salt intake appropriately for their lifestyles.
      I know that you know the dangers of low salt, but please continue to spread the word regarding hyponatremia. Be sure to send your friends and family to my blog. There is an increasing risk of developing it especially in the elderly, and by sharing your knowledge you can save a life!!!
      Thank YOU!!!

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