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In milder hyponatremia (due to increased losses common in preterm infants) we typically supplement orally with NaCl and start with 4mmol Na/kg/day, split into four doses/24h (so 1 mmol Na/kg/dose x 4).

In cases of higher losses (like use of thiazid diuretic) one needs to supplement more, sometimes we end up with ~10 mmol Na/kg/day

Found this protocol from the UK, we do similary: http://mm.wirral.nhs.uk/document_uploads/shared-care/SodiumChloridesharedcare guideline14.pdf

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thanks you sir. This supplementation in countries where dont exists sodium cloride tablets, can i give as 0.9% saline solution?  this supplementation is after o before of breastfeeding?  can mix with breastmilk or not? thanks you again

Edited by Emilio Escobar
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On 9/17/2020 at 12:30 PM, Emilio Escobar said:

can i give as 0.9% saline solution

You can, in the sense that it is physically possible, however this is likely not advisable as the volumes involved are too large.  0.9% NaCl is 154mEq/L.  1mEq Na = 1mmol.  1mmol Na/kg = ~6.5mL/kg.  Over the course of a day 4mmol/kg/d is ~25mL/kg/d.  By way of comparison, our local liquid NaCl preparation is 2.5mEq/mL so 4mmol/kg/d is <2mL/kg/d.

My advice is that if NaCl tablets are not available in your country but you have a pharmacy capable, see if you can source NaCl powder.  146g NaCl plus QS sterile water to 1000mL final volume will give you a bulk solution of the appropriate concentration.

Alternatively (and I have never done this, nor am I aware of anyone who has done this safely) 3% and 5% IV NaCl solutions are often stocked for use in neurosurgical patients.  The required volume would be a more reasonable ~8mL/kg/d or 5mL/kg/d with either of those solutions.

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We have done the supplementation with 3 % Nacl , and works well . WE mix n EBM and give. Perceiving that this would not taste good we prefer to give 4 hrly instead of 6 hrly . 

Would be interested to know ,

what s the avg time experience for the correction . (Usually it takes between 1 to 3 weeks ,,,,,is t the same for others )

Also, what is the wait time period on which the dose is increased  ( 1 day or upto 72 hrs)

 

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On 9/21/2020 at 2:50 PM, Dr Ashish Jain said:

what s the avg time experience for the correction . (Usually it takes between 1 to 3 weeks ,,,,,is t the same for others )

Also, what is the wait time period on which the dose is increased  ( 1 day or upto 72 hrs)

If you are asking about enteral supplementation for the 'normal' hyponatremia that ELBWs get after the initial diuresis is complete, our goal is to correct this over a week, though often it takes us 2 weeks to get it right.  We follow electrolytes and increase dosing every 2-3 days, paying at least as much attention to the chloride as the Na (we occasionally need to do a mix of NaCl and NaHCO3)

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On 9/26/2020 at 11:26 PM, Mohan said:

Just a thought. Since these solutions(3% saline and Sod Bicarb) are hyperosmolar can they increase the risk of NNEC

As a practical matter, it is unlikely because the volumes are so small that when dissolved in feeds over the course of the day their impact is negligible

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