What causes hypernatremia in newborns?

Key Points. Hypernatremia is usually due to dehydration (eg, caused by diarrhea, vomiting, high fever); sodium overload is rare. Signs include lethargy, restlessness, hyperreflexia, spasticity, hyperthermia, and seizures. Intracranial hemorrhage, venous sinus thrombosis, and acute renal tubular necrosis may occur.

What is neonatal hypernatremia?

Introduction: Neonatal hypernatremia is a serious condition in the newborn period. We present infants with hypernatremic dehydration due to breast milk (BM) hypernatremia. Hypernatremic dehydration in breast-fed newborns is usually secondary to insufficient lactation.

How is infant hypernatremia treated?

If the cause is dehydration, restore circulating blood volume with 0.9% saline and then give 5% dextrose/0.3% to 0.45% saline solution IV in volumes equal to the calculated fluid deficit. Rehydrate over 2 to 3 days to avoid a too-rapid fall in serum sodium, which can have significant adverse consequences.

How do you fix hypernatremia in neonates?

Rapid correction of increased serum Na concentration predisposes to osmotic changes in the brain which can exacerbate the existing cerebral edema. Hence, oral rehydration with expressed BM or direct breastfeed or a fluid rehydration at a rate of 100 ml/kg/ day can be done.

Which complication may result from the treatment of hypernatremia?

If hypernatremia is corrected too rapidly, brain edema and associated neurologic sequelae can occur. Patients with chronic hypernatremia are especially prone to this complication.

What is the pathophysiology of hypernatremia?

In both patient groups, hypernatremia is caused by impaired thirst and/or restricted access to water, often exacerbated by pathologic conditions with increased fluid loss. The development of hyperosmolality from the water loss can lead to neuronal cell shrinkage and resultant brain injury.

What IV fluid is best for hypernatremia?

Patients should be given intravenous 5% dextrose for acute hypernatremia or half-normal saline (0.45% sodium chloride) for chronic hypernatremia if unable to tolerate oral water.

What are the complications of hypernatremia?

Hypernatremia typically causes thirst. The most serious symptoms of hypernatremia result from brain dysfunction. Severe hypernatremia can lead to confusion, muscle twitching, seizures, coma, and death.

What is the most common cause for hypernatremia?

(See ‘The importance of thirst’ below.) Although hypernatremia is most often due to water loss, it can also be caused by the intake of salt without water or the administration of hypertonic sodium solutions [3]. (See ‘Sodium overload’ below.) Hypernatremia due to water depletion is called dehydration.

Is hypernatremia dehydration common in breastfed babies?

Hypernatremia was previously thought to be unusual in breast-fed babies. Nevertheless, from 1979 to 1989, there were sporadic reports of hypernatremia dehydration occurring in breast-fed babies.[2,3,4,5,6] Since 1990s, there has been an increase in the number of breastfed infants reported to have hypernatremia and hypernatremic dehydration.

What are hyponatremia and hypernatremia?

Hyponatremia and hypernatremia are complex clinical problems that occur frequently in full term newborns and in preterm infants admitted to the Neonatal Intensive Care Unit (NICU) although their real frequency and etiology are incompletely known. Pathogenetic mechanisms and clinical timing of hypo-h …

What is hypernatremia in neonatal nephropathy?

Neonatal Hypernatremia. Hypernatremia is a serum sodium concentration > 150 mEq/L, usually caused by dehydration. Signs include lethargy and seizures. Treatment is cautious hydration with IV saline solution.

What is the normal range of hypernatremia?

SODIUM  HYPONATREMIA <135 meq/l  NORMAL 135-145  MILD HYPERNATREMIA 146-149  MODERATE HYPERNATREMIA 150-169  SEVERE HYPERNATREMIA >170  Hypernatremia is always associated with hyperosmolality. Clinical practice guidelines: Hypernatremia. The Royal Children’s Hospital, Melbourne (2012) 5. Edelman equation 6.