A hypernatremia is a serum sodium concentration> 150 mEq / L, mostly by dehydration caused. Symptoms include. a. Lethargy and seizures. The therapy consists of a careful infusion of saline.
A hypernatremia is a serum sodium concentration> 150 mEq / L, mostly by dehydration caused. Symptoms include. a. Lethargy and seizures. The therapy consists of a careful infusion of saline.
(Hypernatremia in adults is treated elsewhere.) A hypernatremia is a serum sodium concentration> 150 mEq / L, mostly caused by dehydration. Symptoms include. a. Lethargy and seizures. The therapy consists of a careful infusion of saline. , Etiology hypernatremia develops when the water over sodium (hypernaträmische dehydration) is lost sodium intake exceeds the sodium losses (salt poisoning). Both A preponderance of water loss compared to salt loss is common in diarrhea, vomiting, or high fever. By refusing food in the first few days (eg. As if both mother and child, breastfeeding or sucking learn) or VLBW infants with a gestational age of 24-28 weeks, this problem can occur. In VLBW children the evaporation of water through the immature water permeable stratum corneum in conjunction with a decrease in renal function and reduced ability to concentrate the urine, loss of free water. By heat lamps and phototherapy lamps there is a significant loss of free water; exposed VLBW children may require up to 250 ml / kg / day i.v. Water in the first few days, until the stratum corneum then begins to develop and the insensible perspiration decreases. A rare cause is central or nephrogenic diabetes insipidus. Infants with hypernatremia and dehydration are often seems more than dehydrated than in the physical examination because the increased osmolality helps the extracellular space (and thus the circulating blood volume) to obtain. A salt overloading is usually caused by excessive use of salt in the preparation of infant formula or by administering hyperosmolar infusions. FFP and human albumin containing sodium and can lead to hypernatremia in very premature infants. Symptoms Typical symptoms of hypernatremia include lethargy, restlessness, hyperreflexia, spasticity and seizures. The skin condition may appear doughy rather than reduced. Among the serious complications include intracranial hemorrhage, the sinus thrombosis and acute renal tubular necrosis. Diagnostic serum sodium concentration due to the symptoms can presumed diagnosis of hypernatremia and confirmed by the determination of the serum sodium concentration. Other laboratory abnormalities include increased urea concentration, a moderate rise in blood sugar levels and, at low potassium, a reduced serum calcium level. Treatment 0.9% saline iv, then hypotonic saline solution (0.3% strength by weight or 0.45% saline solution) are restored First, the circulating blood volume With strongly dehydrogenated infants must, generally with 0.9% saline in portions of 20 ml / kg iv Treatment consists of i.v. Infusion of 5% dextrose and 0.3-0.45% sodium chloride solution. The infusion volume corresponds to the fluid deficit determined (s. A. Treatment) and is added over a period of 2-3 days to prevent too rapid decrease of serum osmolality, and thus too rapid a liquid displacement in the cells with the risk of cerebral edema. The regular maintenance infusion was to be given independently in parallel. The goal of therapy should be the serum sodium levels lower by about 10 mEq / day. Body weight, serum electrolytes, urine volume and specific gravity must be checked periodically, so that the fluid therapy can be adjusted accordingly. Once a good diuresis is present, potassium should be added to meet the normal requirements and compensate for the loss in the urine. Clinical Calculator: Calculate the maintenance requirement of fluid in children caused by a Salzintoxikation extreme hypernatremia (serum sodium> 200 mEq / l) should be treated with peritoneal dialysis, v. a. if the intoxication causes a further rapid increase in serum sodium. Prevention For prevention of hypernatremia is required special attention in terms of volume and composition of the fluid losses and the infusion solutions used for volume adjustment. The risk is v. a. in neonates and young infants who are not yet able to signal their thirst appropriate and balance their fluid loss, is the largest. The food composition requires special attention, v. a. if the food still to be prepared or mixed (such as. for example, in some commercially available infant formulas or concentrated tube feeding), v. a. when the risk of dehydration is high, as with diarrhea, food refusal, vomiting, or high fever. Key points A ypernatriämie usually arises due to dehydration (eg caused by diarrhea, vomiting, high fever.); Sodium overload is rare. Symptoms are lethargy, restlessness, hyperreflexia, spasticity, hyperthermia and seizures. There may be intracranial hemorrhage, sinus thrombosis and acute renal tubular necrosis. Diagnosis before at a serum sodium concentration> 150 mEq / L. If the cause is dehydration, make the circulating blood volume with 0.9% saline and then will give 5% D / W / 0.3% to 0.45% saline i.v. in volume equal to the calculated fluid deficit. Rehydration about 2 to 3 days to avoid a too rapid decrease of serum sodium.