Hypernatremic Dehydration Research Articles

Déshydratation hypernatrémique et allaitement maternel

Hypernatremic dehydration due to breast-feeding is a rare complication during neonatal period, and can expose neonates to severe sequels. A 7-day-old exclusively breast-fed male, with a birth weight of 2800 g, had suffered from severe dehydration with acute renal failure and metabolic acidosis, with 170 mmol/l of serum sodium and 7,1 mmol/l of serum potassium, rapidly complicated with seizures. Renal and brain ultrasounds were normal. The hypernatremic dehydration was contributed to an excess of sodium intake. The rate of sodium in mother's milk was three times as high that witness (97 vs 36 mmol/l). Careful intravenous rehydration allowed the correction of hydroelectrolytic disorders and cure without effects. In this observation, the authors present a rare complication of breast-feeding, and severe neonatal dehydration.

Hypernatraemic dehydration in exclusively breastfed infants: a potentially fatal complication

There have been several reports in the literature about hypernatraemic dehydration and severe malnutrition in exclusively breastfed infants. The authors report a series of four such cases admitted to the Newborn Special Care Unit of the University Hospital of the West Indies over a seven-year period. All four were term infants who had weight loss of greater than 20% of their birthweight, serum sodium levels greater than 175 mmol/L, metabolic acidosis and pre-renal failure at presentation. Three of the infants had seizures shortly after presentation. One of the infants died soon after admission to hospital, the three others had normal neurological development clinically at the time of last review.

Reference chart for relative weight change to detect hypernatraemic dehydration

Objective: The validity of the rule of thumb that infants may have a weight loss of 10% in the first days after birth is unknown. We assessed the validity of...

Severe Hypernatremic Dehydration Secondary to Undetected Lactation Failure: Usefulness of Sodium Levels in Breast Milk

There is a concern that lactation failure and neonatal morbidity might be more common than previously thought. Maybe the early discharge, the lack of timely follow-up, or poor information during pregnancy or after delivery play important roles. A case of severe hypernatremic dehydration secondary to lactation failure is reported and we analyze recent recommendations.

Adipsic diabetes insipidus following pituitary surgery for a macroprolactinoma

Adipsic diabetes insipidus (ADI) is a rare condition in which thirst, an essential clinical feature for the prevention of hypernatraemic dehydration, is absent. We report the first case of adipsic diabetes insipidus to occur following surgery for a pituitary macroprolactinoma, with loss of both osmoregulated and baroregulated vasopressin release. Following extensive surgery for a vision threatening macroprolactinoma a 14-year-old boy developed profound hypernatraemia with absent thirst sensation. Detailed investigation, with hypertonic saline infusion and trimetaphan infusion, revealed absence of both osmoregulatory and baroregulatory release of vasopressin. We discuss the investigation and management of such patients and the physiology of hypothalamic-neurohypophyseal dysfunction in such patients.

La déshydratation hypernatrémique chez l'enfant : étude rétrospective de 105 cas

The hypernatremic dehydration defined by a serum sodium concentration > to 150 mmol/l, is a particular form of acute dehydration and constitutes a medical emergency requiring a prompt and adequate diagnosis and management. Purpose. – To precise the epidemiological profile, course, causes and therapeutic particularities of hypernatremic dehydration in children. Population and methods. – Retrospective review of 105 children admitted in the general Paediatrics department of the Fattouma Bourguiba university hospital in Monastir (Tunisia), for hypernatremic dehydration between January 1st 1990 and December 31 2002. Results. – Hypernatremic dehydration represented 11,51% of all kinds of dehydration. The mean age was 6.5 months with a small male predominance. The socio-economic level of the parents was good in 62.8% of cases. Half of the children were in shock. Severe dehydration was present in 87.6% of cases and neurological signs were observed in 77.14% of cases. The initial mean serum sodium concentration was 159 mmol/L. Acidosis and acute renal failure were associated respectively in 97.2% and 76.2% of cases. Prominent cause of hypernatremic dehydration was diarrhoea (94.3%). Intravenous rehydration with 5% glucose solution at the average of 147 ml/kg/day and containing a mean sodium level of 42 mmol/L was performed in 74% of cases. In most cases (84.1%) serum sodium was normalized within the first 72 hours. Complications were noted in 5.7% of cases and mortality rate was 11.4%. Conclusion. – Hypernatremic dehydration was common in infant and the prominent cause is still dominated by diarrhoea in our country. The management of hypernatremic dehydration is based on oral or intravenous rehydration and plasma expanding fluids when shock is present or imminent. The serum sodium concentration should be gradually corrected and should not exceed 0,5 mmol/L/h. Prevention is based on the pursuit of breastfeeding and the use of oral rehydration solution in infantile diarrhoeas.

¿Es frecuente la deshidratación hipernatrémica como causa de readmisión hospitalaria en recién nacidos?

Objective : To identify the incidence and clinical forms of hypernatremic dehydration associated with jaundice in newborns admitted to a community hospital. Method : A prospective and descriptive study including term-newborns admitted with jaundice, who were divided in 2 groups, with or without hypernatremia. A comparison was made according clinical characteristics, age at readmission, weight loss, fever, bilirubin levels, use of antibiotics, neurological abnormalities and mortality. Results : 24 newborns were admitted in 1 year; half of them presented increase sodium levels (average = 163,92 mmol/lt). The incidence was 5/1 000 newborns alive. We did not find differences between the perinatal characteristics or bilirubin levels in both groups, whereas weight loss was higher in the dehydrated group. Conclusions : The incidence of hypernatremic dehydration associated with fever and jaundice seems bigger than previous reports.

Breastfeeding-Associated Hypernatremia: Are We Missing the Diagnosis?

To assess the incidence and complications of breastfeeding-associated hypernatremic dehydration among hospitalized neonates. A retrospective study was conducted at Children's Hospital of Pittsburgh over a 5-year period, to identify otherwise healthy term and near-term (> or =35 weeks of gestation) breastfed neonates (<29 days of age) who were admitted with serum sodium concentrations of > or =150 mEq/L and no explanation for hypernatremia other than inadequate milk intake. The incidence of breastfeeding-associated hypernatremic dehydration among 3718 consecutive term and near-term hospitalized neonates was 1.9%, occurring for 70 infants. These infants were born primarily to primiparous women (87%) who were discharged within 48 hours after birth (90%). The most common presenting symptom was jaundice (81%). Sixty-three percent of infants underwent sepsis evaluations with lumbar puncture. No infants had bacteremia or meningitis. Infants had hypernatremia of moderate severity (median: 153 mEq/L; range: 150-177 mEq/L), with a mean weight loss of 13.7%. Nonmetabolic complications occurred for 17% of infants, with the most common being apnea and/or bradycardia. There were no deaths. Hypernatremic dehydration requiring hospitalization is common among breastfed neonates. Increased efforts are required to establish successful breastfeeding.

391 A Reference Curve for Relative Weight Loss for Breast-Fed Infants to Detect Hypernatraemic Dehydration

BACKGROUND/AIMS: To construct a reference growth chart for breast-fed infants between postnatal day 2 and 11 and to assess its validity in detecting infants with hypernatraemic dehydration. The participants are 1,544 healthy (exclusively) breast-fed infants with 3,075 measurements born during 2002 in three primary care midwife practices in the Netherlands and 83 cases of breast-fed infants with hypernatraemic dehydration obtained by a search of the literature. METHODS: Outcome measure was relative weight loss (weight loss compared to birth weight in %). A reference chart for relative weight loss was obtained by the LMS method, in which centiles are estimated by the Box-Cox power (L-curve), the median (M-curve) and the coefficient of variation (S-curve). RESULTS: The 0.6 centile (= -2.5 SDS) is -11.1% (2 days), -11.9% (3 days), -11.8% (4 days), -11.3% (5 days), -11.0% (6 days), -10.6% (7 days), -10.2% (8 days), -9.8% (9 days), -9.6% (10 days) and -9.5% (11 days). This centile is used as a test to detect children at risk of hypernatraemic dehydration. The test is considered positive if a breast-fed child's relative weight loss decreases below -2.5 SDS and negative if it stays above. Sensitivity (percentage of infants with hypernatraemic dehydration with a positive test) is 86%. Specificity is by definition 99.4%. Positive predictive value is 9.3%, assuming a prevalence of 7.1 per 10,000 breast-fed infants. Cases with a negative test have a mean plasma sodium concentration of 153 mmol/l and cases with a positive test have a mean sodium concentration of 163 mmol/l. CONCLUSIONS: A growth chart for relative weight loss for breast-fed infants in the first days after birth can be helpful to detect infants at risk of hypernatraemic dehydration.

Index of Suspicion in the Nursery

Index of Suspicion in the Nursery

Severe hypernatraemic dehydration in a breast-fed neonate

Severe hypernatraemic dehydration in a breast-fed neonate

May the Best Friend be an Enemy if not Recognized Early

Hypernatremic dehydration is a serious condition in the newborn period. We present 5 infants with hypernatremic dehydration due to breastfeeding; one of them died because of brain edema during treatment.Hypernatremic dehydration in breast-fed newborns is secondary to insufficient lactation and all mothers should be encouraged about breastfeeding, taught the signs of successful breastfeeding, and the warning signs of dehydration. Here, we discuss hypernatremic dehydration in breastfeeding neonates, its causes and treatment.

Hypernatraemic dehydration in breastfed infants: is caesarean section a risk?

"Hypernatraemic dehydration in breastfed infants: is caesarean section a risk?." Annals of Tropical Paediatrics, 25(2), pp. 147–148

Treating Hypernatremic Dehydration

1. Andrew L. Schwaderer, MD 1. Fellow, Pediatric Nephrology 1. George J. Schwartz, MD 1. Professor of Pediatrics Chief, Division of Pediatric Nephrology University of Rochester School of Medicine & Dentistry Rochester, New York In the November 2004 “Index of Suspicion,” Case 1 featured a patient who had hypernatremic dehydration. Dr Scott Hamilton raised the issue of which intravenous solution should be used to treat this condition, given the dangers inherent in lowering the serum sodium level too quickly. Drs Schwaderer and Schwartz have written this commentary to guide clinicians through the complexities of this therapeutic challenge. During most of January, an earlier version of this commentary was printed in the online edition of Pediatrics in Review. This amended version, which was substituted online in late January for the previous commentary, is the text that readers should consult because some corrections were made by the authors. — LFN Hypernatremia, a frequently encountered electrolyte disorder, is defined as a serum sodium level greater than 145 mEq/L (145 mmol/L) and represents a deficit of water in relation to total body sodium. Hypernatremic dehydration may be caused by pure water loss (diabetes insipidus), hypotonic fluid loss (vomiting or diarrhea), or hypertonic sodium gain (hypertonic feeding preparations such as improperly prepared infant formula). (1) Severe hypovolemic hypernatremic dehydration induces brain shrinkage, which can tear the cerebral blood vessels, leading to cerebral hemorrhage, seizures, paralysis, and encephalopathy. (2)(3) Infants who have severe hypernatremia (serum sodium, >160 mEq/L [160 mmol/L]) often present with muscle weakness, a high-pitched cry, insomnia, or lethargy. (1) Younger children tend to have both a higher morbidity and mortality with severe hypernatremia. (2) Breastfeeding hypernatremic dehydration results when a mother-infant feeding interaction is inadequate. In this case, human milk production is limited, and the physiologic decline in human milk sodium concentration does not occur. (4) Forty cases of hypernatremia due to human milk failure have been described in the medical literature. …

Treating Hypernatremic Dehydration

Treating Hypernatremic Dehydration

Bilateral symmetrical hypodensities in the thalamus in a child with severe hypernatraemia

Received: 17 August 2004 Revised: 6 September 2004 Accepted: 6 September 2004 Published online: 11 March 2005 Springer-Verlag 2005 A 4-month-old boy was admitted with diarrhoea, poor oral intake, vomiting, lethargy and convulsions. Serum electrolyte levels were: sodium 199 mEq/l, potassium 6.3 mEq/l, calcium 7.6 mg/dl, phosphorus 5.2 mg/dl, BUN 47 mg/dl and creatinine 1.1 mg/dl. Brain CT showed bilateral symmetrical hypodensities in the thalami (Fig. 1). He was treated for hypernatraemic dehydration with appropriate IV fluid and electrolyte therapy. His condition deteriorated and he died following cardiac arrest 10 h later.Hypernatraemia is a physiological disturbance defined as a concentration of 150 mmol/l or more of sodium in serum. Important aetiologies in children include gasPediatr Radiol (2005) 35: 449–450 DOI 10.1007/s00247-004-1366-6 CLINICAL IMAGE

Hypernatraemic dehydration in Jamaican breastfed neonates: a 12-year review in a baby-friendly hospital

A 12-year retrospective review of neonates admitted with hypernatraemic dehydration to the neonatal unit of the University Hospital of the West Indies was conducted between 1 January 1990 and 31 December 2001. Twenty-four infants fulfilled the criteria for hypernatraemic dehydration. Nineteen (79%) women were either nulliparous or primiparous with a mean (SD) age of 26.9 (4.4) yrs. Modal length of hospital stay for mothers was 24 hrs. Twenty (83.3%) infants were exclusively breastfed. Mean (SD) age at presentation was 7.4 (3.8) days. Mean (SD) percentage weight loss between birth and presentation was 18.9% (6.3). Mean (SD) serum sodium at presentation was 164.8 (13.9) mmol/L. Babies visited at home by nurses had a lower mean serum sodium, were less dehydrated and were significantly less acidiotic. Their mean (SD) length of hospital stay was also significantly less [4.2 (1.4) days] than those who were not visited [7.9 (3.8) days] (p < 0.05). Complications occurred in 19 (79%) of infants and included renal failure (19, 79%), seizures (3, 13%) and intraventricular haemorrhage (1, 4%), and one died (4%). Hypernatraemic dehydration is an uncommon complication of failure to establish breastfeeding but is associated with severe morbidity and mortality. Education programmes are needed to increase awareness amongst health-care workers and mothers in order to prevent the problem.

Clinical presentation of hypernatremic dehydration in exclusively breast-fed neonates

To identify the clinical presentation of dehydration related to failure of lactation in exclusively breast-fed term infants. A prospective study was performed between January 2000 and June 2003 in Al Qassimi Hospital in the Emirate of Sharjah. Enrollment criteria included term neonates whose birth weight of > 2000 g with no underlying organic illness causing poor feeding admitted for clinical manifestations of dehydration with weight loss of > 10% during the first 2 weeks of life. The control group, a non-randomized sample included healthy full term neonates, seen in Sharjah maternal and child health care center at 4-7 days old for their routine Guthrie screening test. For each dehydrated neonate we took two neonates as controls. Mother's age, parity, length of pregnancy, any pathologic conditions, breastfeeding history and her level of knowledge of lactation was recorded. Neonatal information included mode of delivery, percentage of weight loss, clinical examination, and stool and urine output the previous day. Data was analyzed with Student 't' test and chi-square test. Out of 17208 live births, 29 neonates between the ages of 2-13 days were admitted with weight loss of between 12 and 29% (dehydrated group). 27 patients had hypernatremic dehydration with serum sodium level ranging from 150 to 195 mmol/l. Mean age of admission was 4.9 days. Reasons for admission were: signs of dehydration (55%); hyperthermia (55%); hypoglycemia (27%) and jaundice (59%). The control group included 58 healthy neonates. Their birth weight and age were comparable to those in the dehydrated group. In comparison with the control group, delivery by cesarean section (P< 0.0001), lower level of maternal breastfeeding knowledge (P=0.03), transient inadequate breast milk quantity (P=0.005) and nipple anomalies (P=0.001) was significantly more common in the dehydrated group. Fewer voidings of urine (< 6 times /day) and stool (< 3 times/day) in the previous 24 hours before admission was more frequently observed in the dehydrated group (P < 0.0001). Low level of maternal knowledge in lactation, cesarean section and failure of early postnatal follow up was associated with the neonatal dehydration. Decreased urine and stool frequency might be considered as a warning for failure of lactation.

Permanent Brain Damage from Hypernatremic Dehydration in Breastfed Infants: Patient Reports

Permanent Brain Damage from Hypernatremic Dehydration in Breastfed Infants: Patient Reports

A case of acute renal failure, rhabdomyolysis and disseminated intravascular coagulation associated with severe exercise-induced hypernatremic dehydration

A case of acute renal failure, rhabdomyolysis and disseminated intravascular coagulation associated with severe exercise-induced hypernatremic dehydration