Hypernatremic Dehydration Research Articles

Dehydration: Isonatremic, Hyponatremic, and Hypernatremic Recognition and Management.

1. Karen S. Powers, MD, FCCM* 1. *Pediatric Critical Care, Golisano Children’s Hospital, University of Rochester School of Medicine, Rochester, NY. Clinicians need to recognize the signs and symptoms of dehydration to safely restore fluid and electrolytes. After completing this article, readers should be able to: 1. Understand that the signs and symptoms of dehydration are related to changes in extracellular fluid volume. 2. Recognize the different clinical and laboratory abnormalities in isonatremic, hyponatremic, and hypernatremic dehydration. 3. Know how to manage isonatremic dehydration. 4. Know how to manage hyponatremic dehydration. 5. Know how to manage hypernatremic dehydration. 6. Recognize how to avoid as well as treat complications of fluid and sodium repletion. 7. Understand which patients are candidates for oral rehydration. 8. Know the proper fluids and methods for oral rehydration. Dehydration is one of the leading causes of pediatric morbidity and mortality throughout the world. Diarrheal disease and dehydration account for 14% to 30% of worldwide deaths among infants and toddlers. (1) In the United States, as recently as 2003, gastroenteritis was the source for more than 1.5 million office visits, 200,000 hospitalizations, and 300 deaths per year. The rotavirus vaccine has significantly decreased the incidence of rotaviral gastroenteritis, and now norovirus is the leading cause in the United States. Water, which is essential for cellular homeostasis, comprises about 75% of body weight in infants and up to 60% in adolescents and adults. Without water intake, humans would die within a few days. (2) The human body has an efficient mechanism of physiologic controls to maintain fluid and electrolyte balance, including thirst. These mechanisms can be overwhelmed in disease states such as gastroenteritis because of rapid fluid and electrolyte losses, leading to dysnatremia, which is the most common electrolyte abnormality in hospitalized patients. (3) Infants and young children are …

Protocolo de manejo en deshidratación hipernatrémica neonatal

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.

Hypernatremic Dehydration in Newborn Infants: A Review

Hypernatremic dehydration is a lethal condition in neonate which adversely affects central nervous system. Important causes of this condition in neonate are vomiting, diarrhea, improper preparation of infant formula, inadequate breast feeding and diabetes insipidus. Hypernatremic dehydration presents usually around tenth postnatal day. Clinical presentation is variable. Some present with lethargy; others are alert and hungry. Some are dehydrated whereas other are apparently hydrated. Treatment of hypernatremic dehydration consists of an emergency phase where restoration of vascular volume with 10 to 20 ml/kg of isotonic intravenous fluid is achieved followed by rehydration phase where sum of free water deficit and maintenance fluid volume is administered slowly. Rehydration is achieved with 5% dextrose in 0.2% normal saline, 5% dextrose in 0.45% normal saline or 0.9% normal saline according to serum sodium level. However, if the serum sodium is greater than 175 mmol/L, various amounts of 3% normal saline should be added. The daily maximum correction rate of serum sodium level should be 15 mmol/L. Addressing the etiological factors timely may be the proper way of prevention of such condition in neonate.

Early sodium and fluid intake and severe intraventricular hemorrhage in extremely low birth weight infants.

Hypernatremic dehydration is an important cause of intracranial hemorrhage. A possible association of intraventricular hemorrhage (IVH) with hypernatremia and/or high sodium intake has been suggested in preterm infants. To investigate the associations of early fluid and sodium intake or serum sodium concentrations with severe intraventricular hemorrhage (IVH) in extremely low birth weight (ELBW) infants, we reviewed the medical records of 169 inborn ELBW infants. Daily fluid and sodium intake, urine output, weight loss and serum sodium concentration during the first 4 days of life were obtained. Patients were divided into the severe IVH (grade 3/4) and the control (no or grade 1/2 IVH) group. The maximum serum sodium concentration and the incidence of hypernatremia did not differ between the two groups. Related to the fluid balance and sodium intake, the risk for severe IVH was strongly associated with total fluid and sodium intake during the initial four days of life. With respect to the fluids other than transfusion, severe IVH can be discriminated only by sodium intake but not by fluid intake. Large randomized controlled trials are required to clarify the causal relationship between the early sodium intake and severe IVH in ELBW infants.

Hypernatremic dehydration in newborns

Hypernatremic dehydration in newborns

Acute kidney injury, hypernatremic dehydration and exclusive breastfeeding

Acute kidney injury, hypernatremic dehydration and exclusive breastfeeding

PREVALENCE OF BREASTFEEDING–ASSOCIATED HYPERNATREMIA AMONG HOSPITALIZED HYPERBILIRUBINEMIC NEONATES

Introduction: This study aimed to assess the incidence of breastfeeding-associated hypernatremia and related risk factors among hospitalized hyperbilirubinemic neonates. Methods: This prospective study was conducted at Nemazee Hospital affiliated to Shiraz University of Medical Sciences during one year to determine the association between hypernatremia (serum sodium concentration of >150 mEq/L) and exclusive breastfeeding of the neonates. During the study period, 122 neonates were recruited and the patients’ history was taken through using the medical records (regarding child delivery) and asking the mother. Laboratory data including total and direct bilirubin levels, serum sodium level and blood urea nitrogen (BUN) were recorded. P-valueResults: The study was carried out on 86 exclusively breastfed neonates (EBFN) and 36 neonates with mixed type of feeding. The incidence of hypernatremia among the EBFN and non-exclusively breastfed neonates (non-EBFN) was 9.3% and 2.7%, respectively. Moreover, 55% of the neonates with hypernatremia had a significant weight loss (>10% cummulative weight loss). A significant correlation was observed between hypernatremia and weight loss (P=0.008). Also, in spring and autumn, no hypernatremia was observed among 53 cases, and during summer and winter, 9 out of 69 neonates (13%) presented with hypernatremia (P=0.042). Conclusion: Hypernatremic dehydration is relatively common among EBFN. Regular weight monitoring, proper breastfeeding and environmental temperature control should be encouraged for preventing breastfeeding-associated hypernatremia.

The healthy newborn hydration model: a new model for understanding newborn hydration immediately after birth.

The normal small volume of breast milk produced in the first 2 days following birth may raise concerns about adequate hydration in breast-fed newborns. These concerns are further magnified when breast-fed infants lose ≥7% of their birth weight within 2 days postnatally. Weight loss following birth is presumably mostly water loss that could result in hypohydration and subsequent hypernatremic dehydration. However, excess fluid loss immediately following birth is a normal and necessary process. Furthermore, newborns exposed to excess fluid intake during labor may need to lose ≥7% of birth weight in the first 2 days following birth in order to achieve euhydration. Normal newborn fluid loss following birth confounds the use of weight loss as the sole measure of newborn hydration. We thus propose the healthy newborn hydration model that highlights the normalcy of newborn weight loss immediately following birth and the healthy newborn's compensatory mechanisms for preserving adequate hydration. We also recommend the use of serum sodium to measure intravascular osmolarity in addition to monitoring weight loss to obtain a more comprehensive newborn hydration assessment. Research is necessary in healthy newborns to identify relationships among fluids received in utero, newborn weight loss, and hydration, as evaluated with laboratory measures, in the first 2 days following birth. This information will guide clinicians in correctly identifying newborns with inadequate hydration who are in need of supplementary fluids versus newborns with adequate hydration for whom exclusive breast-feeding can be supported and encouraged.

Charts for Weight Loss to Detect Hypernatremic Dehydration and Prevent Formula Supplementing

Most breast-fed newborns get the milk they need. However, very rarely milk intake is insufficient mostly as a result of poor breastfeeding techniques. Dramatic weight loss and hypernatremic dehydration may occur. Our aim was to construct charts for weight loss. A case-control study was performed. Charts with standard deviation score (SDS) lines for weight loss in the first month were constructed for 2,359 healthy breast-fed term newborns and 271 cases with breastfeeding-associated hypernatremic dehydration with serum sodium level > 149 mEq/L. Day 0 was defined as the day of birth. Many cases with (or who will develop) hypernatremic dehydration (84%; +1 SDS line) fell below the -1 SDS line at day 3, the -2 SDS line at day 4, and the -2.5 SDS line at day 5 in the chart of the healthy breast-fed newborns. Weight loss of cases with permanent residual symptoms was far below the -2.5 SDS. Already at an early age, weight loss differs between healthy breast-fed newborns and those with hypernatremic dehydration. Charts for weight loss are, therefore, useful tools to detect early, or prevent newborns from developing, breastfeeding-associated hypernatremic dehydration, and also to prevent unnecessary formula supplementing.

English

Diarrhea present initially at early neonatal period is rare and is generally caused by congenital malabsorptive disorders. Congenital glucose-galactose malabsorption (CGGM) is a rare autosomal recessive disorder present as a protracted diarrhea in early neonatal life. A 3 month-old female infant present with chronic diarrhea, severe failure to thrive, hypernatraemic dehydration and nephrocalcinosis was studied. Early onset diarrhea in a patient with consaguionus parents should alert the pediatricians to think about a rare congenital cause of chronic diarrhea that can present with a life threatening condition. Key words: Glucose galactose malabsorption, chronic diarrhea in infancy, congenital.

Acute kidney injury in hypernatremic dehydration in exclusively breastfed babies: don't ignore it!

Acute kidney injury in hypernatremic dehydration in exclusively breastfed babies: don't ignore it!

Complications due to breastfeeding associated hypernatremic dehydration

Objective: The aim was to assess the incidence, presenting features, and complications of breastfeeding associated hypernatremic dehydration among hospitalized neonates. Materials and Methods: A retrospective study over a period of 18 months to identify term and near term (≥35 weeks of gestation) breastfed neonates, who were admitted with serum sodium concentration of ≥150 mEq/l and no apparent explanation for their hypernatremia other than inadequate breastmilk intake. Results: The incidence of breastfeeding associated hypernatremic dehydration among 2100 term and near term neonates was 1.38%. The median serum sodium at presentation was 164 mEq/l (range: 151-191 mEq/l). The mean weight loss in these patients was 10.16% ±6.6%. The reasons for seeking medical attention were refusal of feeds (72.41%), lethargy (68.96%), decreased urine output (44.82%), jaundice (27.58%) and fever (24.13%). Five patients (17.24%) had seizures and three (10.34%) had coagulopathy. Other complications included hypoglycemia, hypocalcemia, acute kidney injury (AKI) (37.93%) and intraventricular hemorrhage. The mean serum creatinine was 1.82 ± 2.5 mg/dl (range: 0.19-9.6). A statistically significant association was seen between serum sodium concentration at presentation and AKI. It was also found that those patients who had AKI had a higher weight loss and had presented later to the hospital than those without AKI. One patient died within 12 h of admission. This child had disseminated intravascular coagulopathy, AKI, and hypoglycemia. Conclusions: Breastfeeding associated hypernatremic dehydration is a serious condition with many serious complications and even results in death if detected late. Health care providers have increasing responsibilities of promoting proper breastfeeding techniques and taking measures for early diagnosis and treatment of this problem.

Hipernatremik dehidratasyon atakları ile gelen cornelia de lange sendromu

Cornelia de Lange syndrome (CDL), is a genetic syndrome characterized by microcephaly, synophrys, long philtrum, intrauterine growth retardation, mental and developmental retardation. Although malformations of the midline brain are common in CDL, holoprosencephaly is not usual. hypernatremic dehydration, central diabetes insipitus can be occur with cenral malformations. In this article we discussed hypernatremic dehydration and central diabetes mellitus complications in a case with CDL associated with haloprosencephaly.

The Evaluation of Neonatal Cases with Hypernatremic Dehydration

The Evaluation of Neonatal Cases with Hypernatremic Dehydration

Prognostic value of amplitude-integrated electroencephalography in neonates with hypernatremic dehydration

Objectives: Hypernatremic dehydration in neonates is a condition that develops due to inadequate fluid intake and it may lead to cerebral damage. We aimed to determine whether there was an association between serum sodium levels on admission and aEEG patterns and prognosis, as well as any association between aEEG findings and survival rates and long-term prognosis.Method: The present study included all term infants hospitalized for hypernatremic dehydration in between January 2010 and May 2011. Infants were monitored by aEEG. At 2 years of age, we performed a detailed evaluation to assess the impact of hypernatremic dehydration on the neurodevelopmental outcome.Results: Twenty-one infants were admitted to the neonatal intensive care unit for hypernatremic dehydration. A correlation was found between increased serum sodium levels and aEEG abnormalities. Neurodevelopmental assessment was available for 17 of the 21 infants. The results revealed that hypernatremic dehydration did not adversely affect the long-term outcomes.Conclusion: The follow-up of newborns after discharge is key to determine the risks associated with hypernatremic dehydration. Our results suggest that hypernatremic dehydration had no impact on the long-term outcome. In addition, continuous aEEG monitoring could provide information regarding early prognosis and mortality.

Hypernatremic Dehydration in Breastfed Infants

Introduction: Since it can cause life-threatening complications in newborns, diagnosis and treatment of hypernatremic dehydration associated with inadequate breastfeeding is important. Materials and Methods: Records of exclusively-breastfed newborns 37-42 weeks with hypernatremic dehydration serum Na ≥150mEq/L admitted between 2006 and 2012 were reviewed retrospectively. Results: The mean gestational age, birth weight, weight loss, maternal age, and age at diagnosis of 26 newborns with hypernatremic dehydration were 38.8±1.1 weeks, 3292±458 gr, 13.5±5.5%, 27.6±4.9 years, and 3.9±3.5 days, respectively. The percentages of female patients, caesarean delivery, and primipar mothers were 57.6%, 61.6%, and 57.6% respectively. Admission complaints were fever 30.7% , poor feeding and jaundice 26.9% , restlessness and hypoactivity 7.6% . Hypernatremic dehydration frequency within first five days, in summer season, during hospitalization were 84.6%, 73%, and 42.3%, respectively. The mean serum BUN, creatinine, Na levels were found 45.6±64.1 mg/dl, 1.5±2.3 mg/dl, and 157±11.9 mEq/L, respectively. Of 26 mothers, 57.6% had received breastfeeding education and 84% had inadequate fluid intake. Among four patients with seizures, three had prerenal failure, one had renal failure requiring dialysis, and brain edema developed in one. Serum Na levels were higher in infants who were baby of primipar mother p=0.002 , born in another hospital p=0.012 , from young mothers p=0.035 , from mothers with no breastfeeding education p=0.007 , and with delayed hospital admission p

Comparison of oral and intravenous fluid therapy in newborns with hypernatremic dehydration

Objective: To evaluate the efficacy and complications of oral and intravenous fluid therapy in newborns with hypernatremic dehydration.Methods: A total of 75 term and near-term (>35 weeks) neonates with hypernatremic dehydration (Na ≥ 150 mmol/L) were included in this retrospective study. The patients were divided into two groups according to therapy approach for rehydration (breast milk-oral formula and intravenous fluid). The decline in sodium concentration (<0.5 mmol/L/h was regarded as safe drop) and complications were analyzed.Results: The mean gestational age, birth weight and age at admission were 38.9 ± 1.4(36–42) weeks, 3341 ± 504 (2500–4500) gram and 4.3 ± 2.6 (1–17) day, respectively. Fever (61.8%) and jaundice (39.4%) were the most common presenting signs. Forty-four (58.6%) of the infants were treated with breast milk and/or oral formula (group 1) and 31 (41.4%) of the infants were treated with IV fluid (group 2). In group 1 and group 2, respectively, mean % weight loss, 5 and 7.5; median serum sodium at admission, 153 and 152 mmol/L; median change in sodium at 12 hours, 7 and 11 mmol/L; and median change in sodium at 24 hours, 10 and 15 mmol/L. The decline in sodium concentration was more safely in group 1 than group 2 at both 12 and 24 hours of rehydration. One patient had convulsion associated with cerebral edema in group 2. Otherwise no complication was observed in both groups.Conclusion: Enteral route for fluid replacement may be safe and effective and may be an alternative to intravenous fluid therapy in newborns with hypernatremic dehydration when clinical situation is stable.

What Is the Safe Approach for Neonatal Hypernatremic Dehydration?

The aims of this study were to evaluate the prevalence, complications, and mortality of hypernatremic dehydration in neonates and to compare the effect of correction rate at 48 hours on mortality and on neurological outcome in the short term. This retrospective study was conducted between January 2007 and 2011 in the neonatal intensive care unit. Term neonates were included. The patients were grouped as follows: group 1 = 150 to 160 mmol/L, group 2 = 161 to 170 mmol/L and group 3 = 171 to 189 mmol/L. Among 4280 neonates, 81 cases (1.8%) had hypernatremic dehydration. Groups 1, 2, and 3 consisted of 55, 23, and 3 patients, respectively. Mortality rates were as follows: 3.6%, 17.3%, and 66.6%. Mean serum sodium (Na) correction rates at 0 to 24 hours and 24 to 48 hours were 0.48 ± 0.2 versus 0.38 ± 0.31 mmol/L per hour (group 1) and 0.49 ± 0.21 versus 0.52 ± 0.28 mmol/L per hour (group 2), respectively. In 32 patients (58.1%) from group 1 and in 13 patients (56.5%) from group 2, correction rate of 0.5 mmol/L per hour or less was achieved. Twenty-two patients developed convulsions, which was the most common complication during therapy. Serum Na greater than 160 mmol/L at admission (odds ratio, 1.9; 95% confidence interval, 1.3-3.7) and serum Na correction rate of greater than 0.5 mmol/L per hour (odds ratio, 4.3; 95% confidence interval, 1.2-6.5) were independent risk factors for death or convulsion. There was a significant difference between groups 1 and 2 in Denver Developmental Screening Test II results (64.1% vs 30.7 %, P = 0.001). Hypernatremic dehydration is an important problem that should be managed properly to avoid adverse outcomes.

Case Studies in Fluid and Electrolyte Therapy

Disorders in serum sodium, hyponatremia and hypernatremia, are frequently encountered in both inpatient and outpatient settings. Many sodium disorders are iatrogenic, caused by inappropriate intravenous fluid management. The methods of prevention and treatment of serum disorders differ based on the underlying disease states. Nine cases are presented to illustrate different aspects of fluid management, with an emphasis on the prevention and treatment of disorders in serum sodium. Key concepts that are discussed are (1) when to use an isotonic fluid versus a hypotonic fluid, (2) when to restrict or liberalize maintenance intravenous fluids, (3) how to use 3% sodium chloride for the treatment of hyponatremic encephalopathy, (4) when to use desmospressin to prevent the overcorrection of chronic hyponatremia, and (5) strategies to treat different causes of hypernatremic dehydration in children.

Hyperosmolar Hyperglycemic State (HHS) in Newly Diagnosed Child with Type 1 Diabetes Mellitus: A Case Report

Turkish Journal of Endocrinology and Metabolism, published by Galenos Publishing. Address for Correspondence/Yazisma Adresi: Ihab Abdulhameed Ahmad MD, Pediatric Endocrinology Unit King Abdulaziz University Hospital, Saudi Arabia E-mail: ihabhalaby2002@hotmail.com Recevied/Gelis Tarihi: 01.11.2012 Accepted/Kabul Tarihi: 17.01.2013 Abs tract Hyperglycemic hyperosmolar syndrome (HHS), which is characterized by marked elevations in serum glucose concentrations and hyperosmolality without signifi cant ketosis, has been rarely reported in children. However, the incidence of this disorder in children is increasing with the rise of frequently reported cases describing HHS in children. We report a 7-year-old male patient who presented with HHS with a new diagnosis of type 1 diabetes mellitus complicated by hypernatremic dehydration. The patient had a good outcome, discharged home within 7 days. Turk Jem 2013; 17: 19-21