Hypernatremic Dehydration Due to Concentrated Infant Formula: Report of Two Cases

Leung, Cheung; Chang, Wen-Cheng; Yeh, Su‐Ling

doi:10.1016/s1875-9572(09)60036-x

Cited by 16 publications

(8 citation statements)

References 10 publications

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“…Absence of dehydration signs in hypernatremic dehydration, due to relative preservation of extracellular fluid compartment and predominantly intracellular dehydration, is a well established fact. 6,10 A weight loss of up to 10% in initial 4-7 days, a daily weight loss of 1-2% and regaining birth weight by 10th day are considered normal in term babies. 1,11 We did not find any significant association between weight loss and serum sodium levels because most of the neonates with hypernatremia had weight loss within physiological limits; though most of the patients with excessive weight loss had hypernatremia.…”

Section: Discussionmentioning

confidence: 99%

Hypernatremia in Early Neonatal Life- Can it be Physiological?

Ahmed¹,

Ahmad²,

Dar³

et al. 2019

IJCMR

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Introduction:Hypernatremic dehydration in neonates is the most dangerous form of dehydration due to complications associated with it as well as its management. This study was planned to study the impact of the significant physiologic changes in body water content on serum sodium concentration in the immediate postnatal period and try to identify risk factors for hypernatremic dehydration. Material and Methods:Only healthy term/near-term babies were included. They were examined on day four of life in the well baby clinic. These neonates were again examined on days seven and ten of life. Blood samples were collected on days four and ten of life, serum was separated and stored at -20°C. These serum samples were processed subsequently and serum sodium and potassium were estimated and compared with weight lost by the neonates.Results: 184 neonates were included in the study. Mean serum sodium level was 149 ± 6.0 mEq/l (range 135-172 mEq/l). Hypernatremia of varying severity was detected in 137 neonates. By day 10 of life sodium levels had normalized in all hypernatremic neonates except one, who was hospitalized on day 5 of life with hypernatremic dehydration. Perception of decreased milk production by mother, higher birth order, delivery by cesarean section and decreased urination in the neonate bore significant association with hypernatremia. Signs of dehydration were clinically discernible in nine patients and all of them had hypernatremia, however, most of the babies didn't have obvious dehydration signs and weight loss was comparable between two groups. Conclusion:Mild to moderate degree of hypernatremia is quite common during physiological dehydration in early neonatal period and adequate breastfeeding appears to be an effective and safe intervention for mild to moderate hypernatremic dehydration.

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Section: Discussionmentioning

confidence: 99%

Hypernatremia in Early Neonatal Life- Can it be Physiological?

Ahmed¹,

Ahmad²,

Dar³

et al. 2019

IJCMR

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“…7 In Taiwan, concentrated infant formula is suggested as a method to relieve constipation, presumably by acting as an osmotic stool softener. 24 Although oral rehydrating solutions are used around the world, salt toxicity from the improper use of these solutions is most significant in countries where people have little knowledge or insufficient information regarding their proper reconstitution. 25…”

Section: Cultural Issuesmentioning

confidence: 99%

Salt Toxicity: A Systematic Review and Case Reports

Metheny¹,

Krieger²

2020

Journal of Emergency Nursing

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The current literature on acute salt toxicity indicates that the condition is rare; however, it is associated with high morbidity and mortality. This article contributes the finding that early recognition and treatment of acute salt toxicity can be lifesaving. Key implications for emergency nursing practice found in this article are being aware that salt poisoning by caregivers is 1 of the more common forms of child abuse; therefore, it is important to consider the possibility of salt toxicity when a child is admitted with unexplained hypernatremia. In addition, close monitoring of intravenous fluid replacement and plasma sodium concentrations is vital during the treatment of acute salt toxicity.

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“…Administration of concentrated infant formula, by careless formula preparation or secondary to confusion in using different spoon sizes supplied with commercial formulas (30 mL/spoonful or 60 mL/ spoonful) may lead to mistakes during preparation, especially by inexperienced and teenage mothers and lead to hypernatremia [59]. Salt poisoning has also been described when an excess of salt is accidentally administered, usually being mistaken for sugar in the preparation of feeds or oral electrolyte solutions [60,61].…”

Section: Mistakes During Preparation Of Infant Formulamentioning

confidence: 99%

Hypernatremia in children

Narchi

2016

J Pediatr Biochem

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Hypernatremia results from a deficit of total body water in relation to the total body's sodium stores. This is caused by two main mechanisms: 1) net water depletion exceeding sodium losses or 2) increased sodium gain exceeding water gain. Net water depletion occurs when increased water loss exceeds sodium loss, either due to extrarenal losses (increased evaporative water losses, hypernatremic dehydration caused by diarrhea) or to renal losses (central and nephrogenic diabetes insipidus, intrinsic renal disease). Insufficient water intake occurs with neonatal hypernatremic dehydration secondary to lactation failure, essential hypernatremia or osmoreceptor dysfunction. Increased sodium gain can be caused by iatrogenic hypernatremia, administration of concentrated infant formula, deliberate abusive water restriction and deliberate or non-accidental salt poisoning. Hypernatremia results in a movement of water across cell membranes from the intracellular to the extracellular space, resulting in cellular dehydration, which, in cells of the central nervous system results in brain shrinkage leading to tearing of cerebral blood vessels and neurological complications. As a protective mechanism, idiogenic osmoles accumulate inside the brain cells to help them retain water intracellularly. However this may lead to cerebral edema during rapid rehydration as these idiogenic osmoles attract water inside the neurons. As the appropriate management of hypernatremia invariably depends on the underlying mechanism and cause, a methodical history taking and clinical examination, with the judicious use of laboratory tests will lead to a precise etiological diagnosis to enable appropriate and timely therapy.

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Hypernatremic Dehydration Due to Concentrated Infant Formula: Report of Two Cases

Cited by 16 publications

References 10 publications

Hypernatremia in Early Neonatal Life- Can it be Physiological?

Hypernatremia in Early Neonatal Life- Can it be Physiological?

Salt Toxicity: A Systematic Review and Case Reports

Hypernatremia in children

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