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Hi! I'd say it depends on who the patient is. We sometimes see relatively well term infants who may suffer from hypertonic dehydration due to lack of established breastfeeding - those cases usually resolve with enteral feeding (by breast of bottle).

I guess you refer to typically preterm infants that commonly get hypernatremic due to negative water balance.

I can recommend this post on eMedicine : http://emedicine.medscape.com/article/976386-overview

The trick to avoid hypernatremia the first few days in life is regular checkups (electrolyte balance, urine output etc) and tailoring fluid administration from those.


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thank you very much!

i had a 25+weeks preterm infant, Wt 900g,he was 14 days!,he need HFO, he had edema,but the urine output was normal,about 3-4ml/kg/h,he was resuscitated for  cardiac arrest in a week.now he has hypernatreamia,about 160-166.his fluid was 100-120ml/kg.d.so what can i do? thank you!

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@lipinghuang I'd aim for sodium-free fluids iv, and an increased total volume/24h than you have, aiming at a normalization of S-Na over 36-48 hours. The edema is extravasal fluid, suggesting capillary leakage - there is a risk the edema only will increase with increasing total water administration. But a 14 days old infant could be given more fluid than 100-120 ml/kg/d, we are usually at 160-180 ml/kg/d at that age.

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