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DOI: 10.1055/s-0039-3400469
Extreme Neonatal Hypernatremia and Acute Kidney Injury Associated with Failure of Lactation
Publication History
23 May 2019
20 October 2019
Publication Date:
26 November 2019 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00029029/202002/lookinside/thumbnails/10-1055-s-0039-3400469_1900028-1.jpg)
Abstract
Hypoalimentation is an important cause of hypernatremic dehydration in neonates; however, extreme values of plasma sodium make it necessary to investigate the differential diagnosis. We report the case of a 20-day-old newborn who was admitted with severe hypernatremic dehydration, with plasma sodium of 213 mEq/L and oliguric acute renal failure. The patient was treated with intravenous fluids for correction of dehydration and peritoneal dialysis for adequate sodium correction. During the etiological study, a 10-fold increase in the concentration of sodium in breast milk was detected. Peritoneal dialysis was an effective therapy in the management of the extreme hypernatremia with sodium correction within the recommended rate. At the 1-year follow-up appointment, the child had normal renal function, normal for age psychomotor development, and neurological physical was unremarkable. In conclusion, we report a case of an unusual extreme hypernatremia with discussion of the underlying pathophysiology and, more importantly, the effective treatment with a mixed approach with intravenous fluids and peritoneal dialysis.
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References
- 1 Bockenhauer D, Zieg J. Electrolyte disorders. Clin Perinatol 2014; 41 (03) 575-590
- 2 Staub E, Wilkins B. A fatal case of hypernatraemic dehydration in a neonate. J Paediatr Child Health 2012; 48 (09) 859-862
- 3 Somers M, Traum A. Hypernatremia in Children. In: Mattoo TK, Kim MS. , eds. Waltham, MA: ; 2018
- 4 Moritz ML, Manole MD, Bogen DL, Ayus JC. Breastfeeding-associated hypernatremia: are we missing the diagnosis?. Pediatrics 2005; 116 (03) e343-e347
- 5 Manganaro R, Marseglia L, Mamì C. , et al. Breast milk sodium concentration, sodium intake and weight loss in breast-feeding newborn infants. Br J Nutr 2007; 97 (02) 344-348
- 6 Mujawar NS, Jaiswal AN. Hypernatremia in the neonate: neonatal hypernatremia and hypernatremic dehydration in neonates receiving exclusive breastfeeding. Indian J Crit Care Med 2017; 21 (01) 30-33
- 7 Anctil S, Carceller A, Chevalier I. , et al. Natremia of healthy term newborns at 48 h of life: influence of feeding patterns. Clin Biochem 2006; 39 (10) 992-996
- 8 Quereshi UA, Bhat JI, Ali SW, Mir AA, Kambay AH, Bhat IN. Acute salt poisoning due to different oral rehydration solution (ORS) packet sizes. Indian J Pediatr 2010; 77 (06) 679-680
- 9 Lavagno C, Camozzi P, Renzi S. , et al. Breastfeeding associated hypernatremia: a systematic review of the literature. J Hum Lact 2016; 32 (01) 67-74
- 10 Anand SK, Sandborg C, Robinson RG, Lieberman E. Neonatal hypernatremia associated with elevated sodium concentration of breast milk. J Pediatr 1980; 96 (01) 66-68
- 11 Aydogan S, Dilli D, Ozyazici A, Cakmakci E, Koyuncu E, Zenciroğlu A. Central diabetes insipidus in an infant with pneumococcal meningitis. Fetal Pediatr Pathol 2019; 38 (01) 80-84
- 12 Polak M, Cavé H. Neonatal diabetes mellitus: a disease linked to multiple mechanisms. Orphanet J Rare Dis 2007; 2: 12
- 13 Biset A, Claris O. Idiopathic central diabetes insipidus in an extreme premature infant: a case report. Arch Pediatr 2018; 25 (08) 480-484
- 14 Mora L, Suárez F. Aproximación diagnóstica de los errores innatos del metabolismo en la unidad de cuidado intensivo neonatal: acidosis metabólica, hiperamonemia e hipoglicemia. Revista Biosalud 2017; 16 (02) 83-95
- 15 Kim YH, Song JH, Kim CJ, Yang EM. Congenital syphilis presenting with only nephrotic syndrome: reemergence of a forgotten disease. J Korean Med Sci 2017; 32 (08) 1374-1376
- 16 Komatsu N, Saijoh K, Jayakumar A. , et al. Correlation between SPINK5 gene mutations and clinical manifestations in Netherton syndrome patients. J Invest Dermatol 2008; 128 (05) 1148-1159
- 17 Fu LL, Ma J, Ma JY. , et al. Analysis of 5 children with congenital thrombotic thrombocytopenic purpura [in Chinese]. Zhonghua Er Ke Za Zhi 2019; 57 (01) 50-54
- 18 Lindner G, Funk GC. Hypernatremia in critically ill patients. J Crit Care 2013; 28 (02) 216.e11-216.e20
- 19 Yildiz N, Erguven M, Yildiz M, Ozdogan T, Turhan P. Acute peritoneal dialysis in neonates with acute kidney injury and hypernatremic dehydration. Perit Dial Int 2013; 33 (03) 290-296
- 20 Lunn A, Watson AR, Suri M. Extreme hypernatraemia, breast-feeding and red skin. Pediatr Nephrol 2010; 25 (02) 379-380
- 21 el-Dahr S, Gomez RA, Campbell FG, Chevalier RL. Rapid correction of acute salt poisoning by peritoneal dialysis. Pediatr Nephrol 1987; 1 (04) 602-604
- 22 Moritz ML, del Rio M, Crooke GA, Singer LP. Acute peritoneal dialysis as both cause and treatment of hypernatremia in an infant. Pediatr Nephrol 2001; 16 (09) 697-700
- 23 Bonilla-Félix M. Peritoneal dialysis in the pediatric intensive care unit setting. Perit Dial Int 2009; 29 (Suppl. 02) S183-S185
- 24 Finberg L, Kiley J, Luttrell CN. Mass accidental salt poisoning in infancy. A study of a hospital disaster. JAMA 1963; 184: 187-190
- 25 Coulthard MG, Haycock GB. Distinguishing between salt poisoning and hypernatraemic dehydration in children. BMJ 2003; 326 (7381): 157-160
- 26 Moder KG, Hurley DL. Fatal hypernatremia from exogenous salt intake: report of a case and review of the literature. Mayo Clin Proc 1990; 65 (12) 1587-1594
- 27 Richmond S. Hypernatraemic dehydration: excess sodium is not the cause. Arch Dis Child Fetal Neonatal Ed 2003; 88 (04) F349-F350