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Hyperosmolar hyperglycemic syndrome

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Sometimes we recieve neonates from others institution at few hours of postnatal age and we discover that they had recieved a great volume of H2O usally as 10% glucose and electrolytes. glycemia is frequently more than 2 g/l (> 11 mmol/l) with natremia > 140-145 mmol/l. have we reason to restrict fluid or electrolytes for him the first days and treat deshydratation at day 3 or 4. have you experience with such iatrogenic problem.


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If perfusion is fine, we would probably decrease volume input to normal, adding sodium in normal amounts, (about 2-3 mmol/kg/d), but follow water balance, renal function tests, and serum electrolytes closely. If the renal function is not compromised for some reason, the infant will probably handle the extra volume and the hypernatremia will resolve spontaneously.

Unless the hyperglycemia results in glucosuria, we would not treat it, just monitor it. If there's a very large urinary output due to glucosuria, we would consider to admin insulin. (My personal experience is that one needs to be really careful with insulin, iatrogenic hypoglycemia may occur...)

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I think the best thing for the neonates here, is prevention rather than cure.

I think it is imperative that you educate your colleagues in distant hospitals however small, who deal with preterm deliveries, regarding the initial management of these premies. It should not be exhaustive as the message will be lost in all the information that you give them. Rather it may be in the sort of printed simple protocols regarding temperature management, fluid therapy, and so on in the initial few days of life of a preterm. I think the point is to keep it as simple as possible. Eg. You can give them a printed protocol (not one from your university hospital - but a simple one made for all doctors; so that even GPs can follow them).It can say that for babies with weight 1000-1500 grams the total fluid should be 80-90 ml/kg/day. The fluid to be given is Dex10 with Cal gluconate. you can write amount of Cal Gluconate to be added is 30 mg/kg/day. Then write how to calculate the rate of IV fluids to be given...in microdops (because rural hospitals may not have sophisticated infusion pumps.). This is just an example data set.....I think you are in a better position to decide what to include in your protocols. You could write them in say languages locally very familiar..maybe Arabic and French.

You could communicate these protocols either by outreach programmes with help of your local department of health or arrange a trainig workshop at your university.

I think you should give each of the doctors who will deal with these premies a printed simple clear protocol book.

Regarding financing this whole educational drive, there are two options. The first one which is difficult is getting your local health body to give you grant. The second way and the easy way is to ask the thousands of pharmaceuticals and nutrition companies to sponsor the whole exercise.

It is really worth the effort. Just imagine the numerous babies who will thank you one day....:)

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