J Pediatr Intensive Care 2020; 09(02): 124-127
DOI: 10.1055/s-0039-3400469
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Extreme Neonatal Hypernatremia and Acute Kidney Injury Associated with Failure of Lactation

Gianfranco Tomarelli
1   Pediatric Intensive Care Unit, Hospital Clínico Metropolitano La Florida, Santiago, Chile
,
Daniela Arriagada
1   Pediatric Intensive Care Unit, Hospital Clínico Metropolitano La Florida, Santiago, Chile
,
Alejandro Donoso
1   Pediatric Intensive Care Unit, Hospital Clínico Metropolitano La Florida, Santiago, Chile
,
Franco Diaz
1   Pediatric Intensive Care Unit, Hospital Clínico Metropolitano La Florida, Santiago, Chile
› Author Affiliations
Further Information

Publication History

23 May 2019

20 October 2019

Publication Date:
26 November 2019 (online)

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.