What causes hypernatremia in infants?

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 Hypervolemic hypernatremia?

Background. Hypervolemic hypernatremia is caused by an increase in total exchangeable Na+ and K+ in excess of an increment in total body H2O (TBW).

Which is a symptom of severe 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.

How is pediatric hypernatremia treated?

Treatment of moderate hypernatraemia due to water deficit

1. Replace water deficit over 48 hours in addition to daily maintenance, with IV sodium chloride 0.9% and glucose 5% (see table for rates)
2. In addition, replace ongoing losses mL for mL (excluding urine) with IV sodium chloride 0.9%

How is hypernatremia treated in newborns?

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.

When should hypernatremia be corrected?

SORT: KEY RECOMMENDATIONS FOR PRACTICE

What is the most common cause of 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 [2]. (See ‘Sodium overload’ below.) Hypernatremia due to water depletion is called dehydration.

What is a critical high sodium level?

In many hospital laboratories 160 mEq/L is chosen as the upper critical value. The evidence of this study suggests that sodium in the range of 155-160 mEq/L is associated with high risk of death and that 155 mEq/L rather than 160 mEq/L might be more suitable as the upper critical level.

How does hypernatremia affect the brain?

When sodium levels in the blood are too low, extra water goes into body cells causing them to swell. This swelling can be especially dangerous for brain cells, resulting in neurological symptoms such as headache, confusion, irritability, seizures or even coma.

How do hospitals treat hypernatremia?

In patients with hypernatremia of longer or unknown duration, reducing the sodium concentration more slowly is prudent. 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.

How do you fix hypernatremia?

How fast can hypernatremia be corrected?

Chronic hypernatremia should be corrected at a rate of 0.5 mEq per L per hour, with a maximum change of 8 to 10 mEq per L in a 24-hour period.

What are the symptoms of hypernatremia in infants?

Symptoms of hypernatremia in infants can include tachypnea, muscle weakness, restlessness, a high-pitched cry, insomnia, lethargy, and coma. Seizures usually occur only in cases of inadvertent sodium loading or rapid rehydration.

Which is the corrective formula for hypervolemic hypernatraemia?

This new formula is the first quantitative approach for correcting hypervolemic hypernatremia by achieving negative Na + and K + balance in excess of negative H 2 O balance. Hypernatraemia is a common electrolyte disorder in hospitalized patients [ 1 ]. It is a disorder characterized by either an absolute or relative free water deficit.

How are neurologic complications related to acute hypernatremia?

Morbidity/mortality. In children with acute hypernatremia, mortality rates are as high as 20%. Neurologic complications related to hypernatremia occur in 15% of patients. The neurologic sequelae consist of intellectual deficits, seizure disorders, and spastic plegias.

Is there an absolute water deficit in hypernatraemia?

Hypernatraemia is a common electrolyte disorder in hospitalized patients [1]. It is a disorder characterized by either an absolute or relative free water deficit. In hypovolaemic or euvolaemic hypernatraemia, there is an absolute free water deficit characterized by the negative mass balance of H 2O (V MB) (Table 1) [2].