hi.i have a neonate 30weeks,na=104 ,and siezure

whats guideline  in your hospital?

Dear Amir ,

A bit of more information would have been helpful to understand the cause of hyponatraemia . Management would differ accordingly .It would have been very helpful if the age , weight trajectory and renal functions and renal output  were mentioned. Also what type and how much of fluids the baby is on currently  . Did MUM required any fluid resuscitation at the time of delivery and what was her serum sodium .

Assuming bay is only few days old is retaining water and not diuresing yet. 

Any hyponatraemia presenting with seizures irrespective of the cause will be treated with 3% Sodium Chloride I V bolus . The aim is to bring the serum sodium at least  upto 120-125 mmols. This level will prevent further seizures. Then onwards slow and gradual increase in sodium should be aimed . Generally 0.5mmols /hour or 12 mmols in 24 hours.  This is achieved only by close monitoring of the serum electrolytes . I would monitor every 6 -8 hours up until sodium is in the safe level . I would monitor urine output and weight .I would restrict the fluids to minimum as long as I am providing enough Glucose Infusion Rate between 4 to 6 mg/kg/min.

If the baby is older and kidney have matured enough to excrete sodium (natriuresis) then sodium supplementation is an option . Sodium supplementation can be then adjusted depending on the the levels .

However the paramount question would be why the sodium is low  and hence this would need to be investigated further .  Causes of hyponatremia are numerous  common being again dilution hyponataemia, Loop diuretics , Sepsis , NEC causing third space loss , premature kidney losing all electrolytes including glucose NA , K , Amino acids , H+ion , calcium , phosphate  ( tubulopathy ) or are syndromes like 21 hydroxyls deficiency.

I hope this will shed some light on this tricky topic . 

 

 

 

 

 

First thing is to repeat study to exclude any possible mistake 

We need to know postnatal age and fluid status, and renal function, suprarenal glands function

Could be anything in range from huge losses ( with...? ), to SIADH, to adrenal crisis

From what our treatment would follow...

Sodium replacement rate, glucocorticoid needs, necessity in diuretics administration...

By the way, ultrasound imaging of brain, adrenals etc would be helpful as well 

 

 

 

 

5 hours ago, khalid said:

Dear Amir ,

A bit of more information would have been helpful to understand the cause of hyponatraemia . Management would differ accordingly .It would have been very helpful if the age , weight trajectory and renal functions and renal output  were mentioned. Also what type and how much of fluids the baby is on currently  . Did MUM required any fluid resuscitation at the time of delivery and what was her serum sodium .

Assuming bay is only few days old is retaining water and not diuresing yet. 

Any hyponatraemia presenting with seizures irrespective of the cause will be treated with 3% Sodium Chloride I V bolus . The aim is to bring the serum sodium at least  upto 120-125 mmols. This level will prevent further seizures. Then onwards slow and gradual increase in sodium should be aimed . Generally 0.5mmols /hour or 12 mmols in 24 hours.  This is achieved only by close monitoring of the serum electrolytes . I would monitor every 6 -8 hours up until sodium is in the safe level . I would monitor urine output and weight .I would restrict the fluids to minimum as long as I am providing enough Glucose Infusion Rate between 4 to 6 mg/kg/min.

If the baby is older and kidney have matured enough to excrete sodium (natriuresis) then sodium supplementation is an option . Sodium supplementation can be then adjusted depending on the the levels .

However the paramount question would be why the sodium is low  and hence this would need to be investigated further .  Causes of hyponatremia are numerous  common being again dilution hyponataemia, Loop diuretics , Sepsis , NEC causing third space loss , premature kidney losing all electrolytes including glucose NA , K , Amino acids , H+ion , calcium , phosphate  ( tubulopathy ) or are syndromes like 21 hydroxyls deficiency.

I hope this will shed some light on this tricky topic . 

 

 

 

 

 

Dear sir

How fast and how much sodium do you correct to 120?

Hello Amir- 

these two attached documents will help you in practical management of severe hyponatremia. While you are correcting serum sodium to bring it to safe levels, you must determine the cause and try to treat the cause too. 

sodium-chloride-3-18022021-3.0.pdf TPA-53-55.pdf