![]() ![]() ![]() ![]() This article is licensed under the Creative Commons Attribution 4.0 International License (CC BY). ![]() Rehydration fluid for values between 180 and 190 mEq/L can be cautiously started with the regime of severe hypernatremia with frequent electrolytes monitoring every 2 h, as mentioned above. If the expected sodium decline is >0.5 mEq/h, the rate of parenteral fluid (by 20%) should be reduced every 2 h until the desired decline is achieved. In the meantime, if no facilities are available for preparing the special solution, start parenteral rehydration therapy with only (0.9%) dextrose (D5) containing 154 mEq/L sodium and keep monitoring serum sodium level closely till a desired decline of sodium is achieved. Therefore, if the serum sodium level is in the extreme category, particularly >190 mEq/L, a pediatric nephrologist should be consulted to discuss the possibility of peritoneal dialysis. However, calculations and preparation of such a solution within the desired time frame are complex and sometimes may not even be possible in some units, particularly in low middle-income countries where the incidence of such conditions is higher. Reports in the literature recommend that clinicians prepare a special solution for this purpose by adding various quantities of 3% sodium chloride (0.514 mEq Na/mL) per liter of 0.9% saline to raise the sodium content of a solution to about 10–15 mEq less than the patient’s serum sodium. In the next section, fluid management will be explained separately for neonates with anuria and a shock-like state and those with observed diuresis and hemodynamically stable.įluid management in extreme hypernatremia (sodium >180 mEq/L) is more complex and not straightforward. Thus, the free and isotonic contents of fluids can be calculated based on their sodium contents, as shown in Table 4, which is further explained later in the review. For example, if serum sodium in ECF is 154 mEq/L and 0.9% sodium chloride is administered intravenously, there will be no net movement of water across the cell membrane however, if the neonate is given 0.45% saline intravenously, then 50% of fluid will be permeable across the membrane hence, this portion is called free water and the remaining 50% will be isotonic and remain on one side of the membrane, allowing it to be osmotically active. In contrast, free water administration will cause the ICF tonicity, particularly in brain cells, to remain high despite a fall in ECF tonicity for an extended period, thereby causing a fluid shift to the ICF and causing cerebral edema with its associated complications mentioned above. Giving too much free water will decrease the ECF tonicity more rapidly than the recommended decrease of 2 mOsm/kg/h or 0.5–1 mEq/L/h. Therefore, the free and isotonic parts of any fluid administered to a neonate for rehydration must be known. While remaining within the ECF, the isotonic part of the parenteral fluid does not affect tonicity and cell volume however, the free water component distributes freely between ECF and ICF compartments, affecting tonicity. Except for dextrose water, any parenteral fluid that is used for rehydration has an isotonic and free water component, as shown in Table 4. ![]()
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