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%

 

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So what is the question?

0.45% saline is the least you can give

Hypernatremia in ELGA babies is likely not due to excessive Na intake 

Even we use half NS in flushes arteriaine , still S.Na is high and associates with hyperchloremia, Cl sometimes rise to 120mmol , Na to 155, what else we should use to overcome this problem

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14 hours ago, nashwa said:

Even we use half NS in flushes arteriaine , still S.Na is high and associates with hyperchloremia, Cl sometimes rise to 120mmol , Na to 155, what else we should use to overcome this problem

 

As @rehman_naveedsaid, this is NOT excess sodium provision. The baby is total body water depleted from all the ways an ELBW can lose free water (mostly skin and urine). You minimize insensible water losses (plastic bag, double wall isolate if available, etc) and, if these measure are not sufficient, provide more free water by increasing your total fluids. Without knowing the details of your fluid management, it is difficult to say more, but from your question, this is almost certainly the problem.

What day of life are you seeing this issue? How much weight loss are you seeing (a marker of water losses early in life)? What is your current fluid management?

We usually start by 100ml/kg /d and increase by 20. We are using humidity of 90 %in incubator.this problem usually happens in first 3-5 days

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I think 0.18% saline is available and would be a better choice in ELBW infants.

Is there any evidence that we should not use less than o.45% saline? we use 0.22% in very small babies during the first days of life

Is there any evidence that we should not use less than o.45% saline? we use 0.22% in very small babies during the first days of life

Any evidence for that ????

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Here is our initial fluid management strategy:

 

<750 grams = 120 mL/kg/day

750 - 1000 grams - 110 mL/kg/day

1001 - 1500 grams = 100 mL/kg/day

 

We use 0.25 or 0.5 Normal saline in our UAC lines, running at 0.5-1 mL/hr. 

 

We do not routinely see hypernatremia in the first week, transient hyponatremia from immature renal function seems more common to us. Outside of the UAC fluids, our babies do not see Na in their maintenance fluids until 2-3 days of life. 

 

Hope this helps

Here is our initial fluid management strategy:
 
750 - 1000 grams - 110 mL/kg/day
1001 - 1500 grams = 100 mL/kg/day
 
We use 0.25 or 0.5 Normal saline in our UAC lines, running at 0.5-1 mL/hr. 
 
We do not routinely see hypernatremia in the first week, transient hyponatremia from immature renal function seems more common to us. Outside of the UAC fluids, our babies do not see Na in their maintenance fluids until 2-3 days of life. 
 
Hope this helps

You are not give Napo4 in TPN ???

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We usually start Napo4 1mmol/kg from 2nd day in TPN

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I use NaCl or NaAcetate in TPN. I can't remember the last time I used NaPO4. It is an option, but we do not use it often. 

 

We do not routinely check electrolytes until day 2-3, nor do we routinely add any supplements other than Ca and protein the first 2 days. 

 

What is happening with the weight of your babies that experience this hypernatremia? What about the urine output? A low UOP and substantial weight drop could imply lack if intravascular free water. 

We use heparinised Glucose 5% in our UACs however the down side is that you cannot use the glucose measurement.