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?

No electrolytes (except possible Ca) in the first day or so, introduce modest amounts of Na and K in IVF/PN on day 2 or 3 based on diuresis and serum Na level.  Closer monitoring is required in ELBW/EPT infants.  In my experience in the early going the biggest problem people get into is giving too much free water as opposed to being off on the amount or timing of Na administration.  After a couple of days the biggest problem, especially in ELBWs, is that massive amounts of acetate given in TPN to compensate for the normal RTA are not adjusted quickly enough and people overshoot and end up with iatrogenic metabolic alkalosis.  Later we see the problem of inadequate provision of NaCl manifesting often as poor weight gain (especially in the ELBW advanced on term donor milk).

Thank you so much