nashwa 22 Posted January 31 Share Posted January 31 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% Sent from my Redmi Note 9 Pro using Tapatalk 1 Link to post Share on other sites
rehman_naveed 68 Posted January 31 Share Posted January 31 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 1 Link to post Share on other sites
nashwa 22 Posted January 31 Author Share Posted January 31 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 Sent from my Redmi Note 9 Pro using Tapatalk Link to post Share on other sites
bimalc 132 Posted February 1 Share Posted February 1 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? 1 1 Link to post Share on other sites
nashwa 22 Posted February 1 Author Share Posted February 1 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 daysSent from my Redmi Note 9 Pro using Tapatalk Link to post Share on other sites
raviagarwal 15 Posted February 8 Share Posted February 8 I think 0.18% saline is available and would be a better choice in ELBW infants. Link to post Share on other sites
carlosaldana 10 Posted February 8 Share Posted February 8 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 Link to post Share on other sites
nashwa 22 Posted February 10 Author Share Posted February 10 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 lifeAny evidence for that ????Sent from my Redmi Note 9 Pro using Tapatalk Link to post Share on other sites
HickOnACrick 29 Posted February 10 Share Posted February 10 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 Link to post Share on other sites
nashwa 22 Posted February 10 Author Share Posted February 10 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 helpsYou are not give Napo4 in TPN ???Sent from my Redmi Note 9 Pro using TapatalkWe usually start Napo4 1mmol/kg from 2nd day in TPNSent from my Redmi Note 9 Pro using TapatalkSent from my Redmi Note 9 Pro using Tapatalk Link to post Share on other sites
HickOnACrick 29 Posted February 10 Share Posted February 10 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. Link to post Share on other sites
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