Concentrated milk feeds and their relation to hypernatraemic dehydration in infants.

Chambers, T L; Steel, A. E.

doi:10.1136/adc.50.8.610

Cited by 41 publications

(16 citation statements)

References 18 publications

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“…Typically, diarrhoea causes water loss, and vomiting prevents intake of water. This condition was common in the 1960s and 1970s, when infant milks were more calorie dense than they are today9 (not because they had higher sodium concentrations, as previously suggested10). …”

Section: Diagnostic Pathway For Childhood Hypernatraemiamentioning

confidence: 66%

Distinguishing between salt poisoning and hypernatraemic dehydration in children

Coulthard

2003

BMJ

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Hypernatraemia caused by salt poisoning or dehydration must be distinguished correctly, as the two situations need different legal and medical approaches. Two nephrologists discuss the physiology of hypernatraemia and explain how to differentiate between cases caused by salt poisoning and dehydrationThe criteria most widely used to diagnose salt poisoning in children were formulated by Meadow.1 These criteria focus on hypernatraemia with high urinary concentrations of sodium and chloride, but this combination may also be found in children with dehydration caused by diarrhoea. The medical and legal management of the two conditions fundamentally are different, so reliable ways to distinguish them are needed.We consider the physiology of salt overload and hypernatraemic dehydration. 2 We explain how to differentiate the two situations on the basis of history; examination; and biochemical analysis of serial, paired, blood, and "spot" urine samples. We illustrate the method with two cases that have been tested in court.

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Section: Diagnostic Pathway For Childhood Hypernatraemiamentioning

confidence: 66%

Distinguishing between salt poisoning and hypernatraemic dehydration in children

Coulthard

2003

BMJ

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“…In the 1970s gastroenteritis with hypernatraemia of relatively acute onset29 was a significant cause of mortality and neurological sequelae in infants 30. Intake of excess sodium in inappropriately prepared formula milks was blamed at the time,29 but a more plausible explanation is that continued feeding with milk after the onset of diarrhoea resulted in the delivery of a protein rich solution to the colon which, after digestion by colonic bacteria, produced a considerable osmotic load 31…”

Section: Discussionmentioning

confidence: 99%

“…Intake of excess sodium in inappropriately prepared formula milks was blamed at the time,29 but a more plausible explanation is that continued feeding with milk after the onset of diarrhoea resulted in the delivery of a protein rich solution to the colon which, after digestion by colonic bacteria, produced a considerable osmotic load 3132 or 4 days 29.…”

Section: Discussionmentioning

confidence: 99%

Hypernatraemic dehydration and breast feeding: a population study

Oddie

2001

Archives of Disease in Childhood

127

108

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As part of a population based regional review of all neonatal readmissions, the incidence of dehydration with hypernatraemia in exclusively breast fed infants was estimated. All readmissions to hospital in the first month of life during 1998 from a population of 32 015 live births were reviewed. Eight of 907 readmissions met the case definition, giving an incidence of at least 2.5 per 10 000 live births. Serum sodium at readmission varied from 150 to 175 mmol/l. One infant had convulsions. The sole explanation for hypernatraemia was unsuccessful breast feeding in all cases. The eight cases are compared with the 65 cases published in the literature since 1979. Presentation, incidence, risk factors, pathophysiology, treatment, and prevention are discussed. (Arch Dis Child 2001;85:318-320)

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“…Dehydration may be associated with hypernatremia.in the following situations:4,14,15 (1) acute loss of water with minimal loss of sodium -e.~. sweating, hyperventilation, increased heat production, low-sodium diarrheas (inexcess intake of sodium in the face of extracellular volume contraction that is the most likely cause of significant hypernatremia.16 In the absence of an excess intake, water loss, even though hypotonic, does not usually lead to hypernatremia, because, in the presence of ADH-induced water retention and aldosterone-induced potassium depletion, transfers of intracellular fluid to the extracellular compartment result in dilution of extracellular sodium.…”

Section: Discussionmentioning

confidence: 98%

Sodium and Water Content of Feedings for Use in Infants with Diarrhea

Walker

Gahol

Quintero

1981

Clin Pediatr (Phila)

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The sodium and water intakes of a group of infants treated for diarrhea and dehydration in 1972-73, when hypernatremia was common, and a group of infants treated for diarrhea and dehydration in 1978-79, when hypernatremia was rare, were compared. Infants from both study periods whose intake was poor and who received feedings containing sodium in concentrations greater than 17 mEq/liter were more likely to develop elevated serum sodium concentrations. In a group of infants recovering from diarrhea, the effect upon the serum concentration of sodium of varying water and sodium intake was studied. Those treated with small amounts of a solution containing 30 mEq sodium per liter regularly demonstrated an elevation of serum sodium, whereas those treated with large amounts of the same solution regularly demonstrated a depression. It is concluded that infants with diarrhea should receive feedings containing sodium in concentrations less than 17 mEq/liter unless a high fluid intake can be assured.

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Concentrated milk feeds and their relation to hypernatraemic dehydration in infants.

Cited by 41 publications

References 18 publications

Distinguishing between salt poisoning and hypernatraemic dehydration in children

Distinguishing between salt poisoning and hypernatraemic dehydration in children

Hypernatraemic dehydration and breast feeding: a population study

Sodium and Water Content of Feedings for Use in Infants with Diarrhea

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