khalid

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 .

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This is the formula we use in our unit 500 /(ml/kg/day)*mmols/kg/day That is 500 divided by the rate of fluids ml/kg/day multiplied by amount of Na or potassium you prescribe in mmols/kg/day. 500 ml is the total volume of fluid you will be adding electrolytes to.. For instance 500/90*3= 16.6 mmols of sodium. you will be adding 16.6 mmols of sodium to 500ml of say 10%dextrose and if u run this fluid at a rate of 90ml/kg/day you will be giving 3mmol/kg/day of sodium.