Fluid & Electrolyte Management

Dear friends, I have never been able to undersatnd the fluid balance calculation in a neonate:confused:...When do we say positive balanve and when negative and what are the implications and what do we do to manage this. eg If a neonate is +/-ve 100mls but satble other wise with a urine output of >1ml/kg/hr I would appreciate any kind of input to explain this to me in detail thanks for your help.

Dear colleagues.. Best wishes... any one has an explanation for occurence of hypocalcemia in preterm baby receiving phototherapy in NICU.. thanks

My cousin's granddaughter has been diagnosed to have hypernatremia on 21 st postnatal day. The mother's breastmilk sodium is 45 .If the mother wants to breastfeed the baby how to go about after sodium becomes normal? Till what level we ask the mother not to breastfeed and supplement with formula? If the mother doesn't have mastitis what is the reason for high sodium in the milk? thanks selvan.r

I would like to know your approach to a newborn with hypernatremia and dehydration. How do you calculate fluid therapy? For example: term newborn, birth weight 3 kg. 7 days of life. In the emergency department the baby weight is 2,600 kg. Na 170 mEq/l. In my hospital we correct taking into account water deficit (0.7* Weight in grams * [ Na/140 − 1]) We correct water deficit in 72 hours. So the fluids would be: Glucose 10% 437,7 ml ClK 1M 5,4 ml ClNa 20% 2,4 ml Calcium gluconate 10% 13,5 ml Drip rate 18,2 ml/h Is there a limit of maximal fluids in 24 hours?

We have started using Sodium acetate as an additive in our TPN. It has shown to be very beneficial in neonates. A nice abstract link is as follows (http://pt.wkhealth.com/pt/re/adcn/abstract.00042223-199707000-00003.htm;jsessionid=GNySJG81pcQhGQHwc2GLMGJSnDFxkyGgbZnDvfTHGPtgtDTX9MpJ!-362743511!181195628!8091!-1) I just wanted to ask the community out there how is their experience with this additive? Any complications? What about use in nenonates with cholestasis? Does acetate conversion to bicarbonate work in presence of severe liver disease? How does the increased pH affect the ultimate Ca and PO4 stability?

:)Good evening ! I wonder about HES in neonatology. Does anybody use hydroxyethylstarch as volumexpander in your practice? What is your opinion about it? Do you know studies about advantages or disadvantages of HES?

Hi Sometimes we recieve neonates from others institution at few hours of postnatal age and we discover that they had recieved a great volume of H2O usally as 10% glucose and electrolytes. glycemia is frequently more than 2 g/l (> 11 mmol/l) with natremia > 140-145 mmol/l. have we reason to restrict fluid or electrolytes for him the first days and treat deshydratation at day 3 or 4. have you experience with such iatrogenic problem. thanks

Hi, i have a 540g baby who i managed with ivf on day 1, then tpn(1 g each of pro and intralipid) and trophic feeds of expressed breast milk starting day2.baby lost 24% of birth wt in the succeeding days.I ended up giving the baby 350 ml/k/d to keep up with the diuresis that ensued. One of my neonatology friends says that in their unit , they are much more aggressive and their babies are managed with 2 g of pro and 1 g of intralipid from day1, then increasing to max 3g/k/d of pro and fat in the next 3 days, and they use only 180ml/k/day of tfr. I am wondering if this practice is widespread. BTW, the baby is doing well and is now almost on full feeds(day 14).