Fluid and electrolyte balance
47 topics in this forum
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Dear colleagues, In our unit, we have some disagreements on what to consider hyperkalemia in newborn and at what threshold we should do something. In my opinion (based on literature review and units protocols available), I consider an elevated potassium when it is above 5,9 – and we usually would see some repercussion when it is above 6.5. I have a lot to discuss about it, but I would like to start with this: what do you consider hyperkalemia? Best regards, Greice Batista
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information, uses and experiences in their units
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Hi all, I am working on setting up a new NICU in a resource limited setting - we are looking for references for making customised TPN bags for our preterm - as no standardised bags are available here. Any good resources on this - other than the ESPGHAN enteral feeding guide?
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Hi, Got into a discussion with a neonatologist now primarily working with clinical pharmacology, so I wanted an international perspective. In those cases when beta-stimulants are indicated for hyperkalemia (not first line treatment), would you always use inhalations, or when would you choose IV? Any experiences with other beta-stimulants besides albuterol?
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Dear Neonatology colleagues, We are conducting a study to better understand knowledge and variations in clinical practice of fluid management in neonates. This survey is being conducted by neonatologists and pediatric nephrologists from the Neonatal Kidney Collaborative. The goal of this project is to summarize practice patterns, identify potential best practices and provide further opportunities for education. https://redcap.link/nkcfluid We anticipate this survey will take approximately 10 minutes. To thank you for your participation, upon completion of the survey you will have the option to enter a raffle for Starbucks gift cards or f…
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hello to the group, we need opinions on the hydro-electrolyte management in children under 28 weeks. we have problems to regulate the weight loss and not to exceed in volume. What volume do you start with? How much weight loss do they tolerate? How much sodium do they provide in this first week? How do you manage patients with high diuretic rhythms that give basal needs greater than 200 ml/kg ? do you replace it ? When a patient loses more than 15% of weight, what strategies do you use to regain it? thank you very much
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hi.i have a neonate 30weeks,na=104 ,and siezure whats guideline in your hospital?
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Do you use Dialysis en extrem preterm less than 500 gr.? In context of anuria (but not after cardiac surgery). Is There an age limit, or a weight limit?.
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In extreme premature babies , we are facing problem of hypernatremia in first days of life because of arterial line flushes even we use sodium 0.45% Sent from my Redmi Note 9 Pro using Tapatalk
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Hi Colleagues May I ask a question, What does free water deficit means for Hypernatremia? I know the definition but what does it actually means when treating hypernatermia with crystolloids solution. For example if serum Na is 190, free water content of 0.9% NaCl is 19%, 0.45% Saline is 59% and 0.2% Saline is 81%. How this will help in giving free water to a baby weight 4Kg with Na 190 mmol/L, who require approximately 576ml of Free water in 4 days to drop Na slowly to 142 mmol/L. Many Thanks in advance.
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IV volumes the first 3 days of life
by Guest danielirra- 2 replies
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Hi I’d like to know your protocol to use Parenteral fluids ( volume) the first 3 day in preterms < 32 weeks and for Term infants we are employing 60-80 ml/k/day first day of solution of D10% with amino acids thanks Danielirra
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Hello 99Nicu, Recently we have had a number of infants who have required IV Dextrose infusions following episodes of low sugars. Does anyone know of or use a specific guideline when reintroducing, regrading back onto enteral feeds and the monitoring of blood sugars? Many thanks Stay Safe Alistair
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Please, do you can share some article about oral supplementation and correction of neonatal hyponatremia or can you share to me a guideline about it or how treat with sodium cloride solution by NG way ? Thanks in advance and God bless you
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With significant transepidermal water loss due to poor skin integrity of 22-23 week gestation, I was wonder if there is any ideas to: 1) secure line access (when tegaderm /occusive dressing does not adhere)? We currently use tegaderm to secure UAC/UVC line along with PICC lines/PIV. But with tegaderm not adhering the first few days of life, difficulty in securing PICC lines. UAC/UVC we can secure in pace with tighter suture. 2) have anyone have experience with No-Sting and if so recommendations and experience? Since the company does not recommend its use. 3) any measures to decrease transepidermal water loss besides: keeping humidified isolette closed…
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Good night . ¿Do you can share to me please the guidelines that you use to oral correction in mild or moderate neonatal hipokalemia? Thanks in advances and God bless you all
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Hi, everyone. I want wondering then you use 3% sodium cloride solution to correct symptomatic hyponatremia, do you use undiluted or add more some solution or strike water? Thanks in advance
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Considering the high protein intake from the first hour, how is your daily practice of administering electrolytes (Na, K, Mg) during the contraction phase of VLBW?
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Hypocalcemia
by agoz- 1 reply
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What is the normal value of calcium for 37th, 36th week premature, same for term? What formula do you use for calcium result correction with albumin value ? Is ionised calcium value in blood gases more valid than total calcium ?
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Dear colleagues! Please share your experience regarding 2 issues about infusion in preterm infants. Unfortunately there are no solid guidelines but questions of fluid supplementation and parenteral nutrition are obviously important for premature patients. There are considerable differences in proposed volumes of fluid requirement per day in literature. For example, Avery’s Diseases of the Newborn (10th edition from 2018, freshest one) provides following numbers: From the other hand, European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2016 Update states that “Typically fluids are initiated at about 70–80 ml/kg/ d…
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how do you guys manage hypernatremia in collodion babies, we have a three-month-old with hypernatremia and hyperaldosteronism and hyperreninemia and oliguria, any suggestion on how to manage?
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I visited Hot Topics last year and one of the best lectures (according to me!) was held by Judy Aschner, about the use of sodium bicarbonate being principally useless (and could even have adverse effects). Please click here to read an excellent review article on the topic by Aschner and Poland. Unfortunately only the abstact is available for free, but the article is worth to order! As many other units, we have a strong tradition to consider the use buffer, if pH is less than 7.25 and BE less than -5 (at least in in ELBW infants) The article by Aschner and Poland has been subjected to some debate in our units. The major argument in favour of buffer is that we do…
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How do you manage fluids in the ELBW - 500g infant? We start at 100 ml/kg/d and increase by ~20 ml/kg daily. Despite plastic wrap in DR, humidified incubators, etc we often have significant hypernatremia usually by 24 hours, sometimes > 150, sometimes > 160. Is this a sodium problem or a water problem or (probably) both? These little guys have lots of transepidermal water loss especially in the first 2 days. They also get Na Acetate via UAC giving sometimes 1.5-2 mEq/kg/d of Na in that first day when the kidneys (from what I read) can excrete free water but cannot filter an excess sodium load well. And some lit suggests retention of birth weigh…
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Dear all, can anyone post any guideline to guide us to manage a 7 day old neonate with hypercalcaemia. Trying to get hold off very specific information about when to start Fursemide (the cut off level for cCa), the dose and when to start bisphosphonates? Thank you. BW, Lenka
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Hi, Just a quick question. In low birth and preterms admitted in NICU, and who have weight fluctuations in first few days, ideally daily weight or birth weight should be used for calculating 24 hour fluid requirements.
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Dear colleagues! Could you clarify for me please where you measure hemoglobin and hematocrit for transfusion? Central or peripheral lines (venous, arterial) or in capillary bed by heelstick? I failed to find much info about that. For example this paper https://doi.org/10.1053/j.semperi.2008.10.006 (pretty old one 2009) states that "central measurements are preferred". If so is the any difference between UAC and UVC hemoglobin and hematocrit? Many thanks!
