Protocolo de manejo en deshidratación hipernatrémica neonatal

Abstract

Neonatal hypernatremic dehydration (NHD) is a severe condition associated with cerebral oedema, intracranial haemorrhage and gangrene. The management of these patients remains controversial due to the complications that have been reported if the correction of serum sodium occurs too quickly. We proposed a protocol to decrease serum sodium slowly. MethodA prospective study was performed with patients who had serum sodium >150 mEq. These patients were treated with a fast load of 0.9% saline solution and maintained with rehydrating solutions consisting of Na 50mEq/L + glucose 5%. Serum sodium was monitored at 12 and 24hrs. ResultsWe included 51 patients in the study, and we identified an NHD incidence of 10.2 cases per 1,000 live births. Average sodium at the time of admission was 158 mEq/L. The average reduction of sodium in the first 12hours was 0.53 ± 0.08 mEq/L/h. In the following 12hours, it was 0.46 ± 0.09 mEq/L/h. No patients presented neurological alterations. ConclusionsRehydration in the neonatal patient with NHD using 1 or 2 loads of 0.9% saline solution, and subsequent management with solutions consisting of Na 50 mEq/L + glucose 5%, were safe for decreasing serum Na levels slowly at a rate of 0.5 mEq/h.