Hypernatremic Dehydration in Newborn Infants: A Review

Abstract

Background: 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. Conclusion: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.

A Prospective Study on the Clinical Features of Hyponatremic Dehydration in Acute Gastroenteritis

“…Jagdishet.al in Turkish province found that 5.6% neonates experience serum sodium concentrations of more than 145 mmol/L in hypernatremia dehydration [6], while our study shows that 29.8% of the infants have serum sodium levels lower than 135 mmol/L in hyponatremic dehydration. Clinical management of hyponatremia depends on treating the fundamental causes however precise assurance of etiology of hyponatremia is not known, additionally, a clinical history might be hard to get because of pediatric population.…”

“…Furthermore, emesis is also an important factor contributing to the fluid loss from the body resulting in electrolyte imbalance. As shown in our study, emesis and diarrhoea leads to hypokalemia as well in few subjects [6]. To tackle this, we need to monitor potassium levels in conjunction with sodium levels.…”

“…In neonate, hypernatremic dehydration might be associated as a weight reduction with over 10% of birth weight toward the finish of first seven day stretch of life or if there is clinical discoveries of lack of hydration with hypernatremia. Hypernatremic dehydration is a possibly deadly condition in neonate which unfavorably influences focal sensory system, prompting destroying outcomes like intracranial discharge, thrombosis, and even demise [6].…”

Clinical profile and outcome of neonates admitted during summer months with dehydration and hypernatremia in tertiary care hospital of central Gujarat, India

“…hypernatremic dehydration in infancy is a medical emergency with high rates of mortality and morbidity. 8 Early diagnosis and prompt treatment is crucial for survival and better prognosis. Mother should be educated about signs and symptoms of dehydration before discharge after delivery.…”

Neonatal Hypernatremic Dehydration and Thrombocytopenia: Its Prevalence and Relationship with Prognosis

“…Clinical symptoms of hypernatremic infants include jaundice, hyperthermia, lethargy, restlessness, mucosal dryness and weight loss of more than 10% (11). In the case of delayed treatment of these infants, serious complications such as seizure, cerebral edema, renal failure and even death may occur (12,13). The follow-up of these infants has shown prolonged neurological complications in severe cases (1).…”