Hypernatremia and dehydration

[Gonzalo Ares]

I would like to know your approach to a newborn with hypernatremia and dehydration.

How do you calculate fluid therapy?

For example: term newborn, birth weight 3 kg. 7 days of life. In the emergency department the baby weight is 2,600 kg. Na 170 mEq/l.

In my hospital we correct taking into account water deficit (0.7* Weight in grams * [ Na/140 − 1])

We correct water deficit in 72 hours.

So the fluids would be:

Glucose 10% 437,7 ml

ClK 1M 5,4 ml

ClNa 20% 2,4 ml

Calcium gluconate 10% 13,5 ml

Drip rate 18,2 ml/h

Is there a limit of maximal fluids in 24 hours?

[Stefan Johansson]

Hi! We would opt for a similar strategy, correction of 48-72 hours.

We probably also give enteral nutrition (mother's milk) and reduce the drips as needed.

Check urine output and follow serum electrolytes closely!

[Guest sameera_reddy]

We follow a little different protocol.Any child with hypernatremic dehydration we always initiate two peripheral IV LINES.We keep the child NPO TILLwe obtain breast milk sodium levels(Beware that irregular feeding itself can elevate breast milk sodium levels).In one IV line we start maintainence iv fluids and in other we start dehydration correction.In one line we start normal saline and in other N/2 saline.Sodium levels are obtained after 6hrs and if drop in Na levels are more than 0.5meq/hr we change N/2 saline Normal saline and if drop is less than 0.5meq/hr we change N/2 saline to N/3 saline and go down in next 6 hrs to N/4 orIsolyte-p.If mother doesnot have mastitis and if breast milk sodium is less than 16 we initiate breast feeding on demand and in next 48-72hrs wean down IV fluids based on Na LEVELS.We always resuscitate a severely dehydrated child with 20ml/kg of NS compared to N/2 saline to avoid sudden drop of Na and resultant cerebral edema.We always keep 3% saline(5ml/kg) ready if in case the drop in Na is rapid and results in seizures

[lizelle.vanwyk]

Does anyone know what the recommendation is as to which fluid is the best to replace the water deficit with when confronted with a few day old 26-week prem with severe hypernatremia. Our protocol states 5% DW but this seems to correct them too quickly (faster than 1 mmol/hr) but is recommended by our hospital. Rehydration is given as 25-30ml/kg extra to the maintenance. Is it better to rehydrate them with 0.45% saline over 24-48 hours rather than 5% DW?

[Guest sameera_reddy]

In preterms we always use 0.45%NS for boluses if they require and also the same for hypernatremia.If the drop is too rapid with this under strict observation we use Normal saline and we usually encounter a problem of hyponatremia compared to hypernatremia in this ELBW'S