Yenidoğan döneminde ağır hipernatremik dehidrasyon

Anne sütü ile beslenen ve erken taburcu edilen bir yenidoğanda yetersiz anne sütü nedeniyle gelişen ağır hipernatremik dehidrasyonun nedenleri ve klinik sonuçlarını literatür eşliğinde sunarak konunun önemini vurgulamak istedik. On beş günlük kız bebek, emmeme, uyuklama, hareketlerinde azalma şikayeti ile başvurdu. Fizik muayenesinde, turgor ve tonusu azalmış, aksiler vücut ısısı 36,70ºC, kalp atım hızı 180/dk, solunum sayısı 40/dk, arteriyel tansiyon 40/20 mmHg, tartısı 2170 (%30 tartı kaybı) olarak saptandı. Diğer sistem muayenesinde bir özellik yoktu. Kan gazında metabolik asidoz, biyokimyasında Na 187 mmol/L, kreatinin 3,9 mg/dl, kan şekeri 220 mg/dl idi. Diğer biyokimyasal ve hormon tetkikleri normal idi. Serbest su açığı ve idamesi 72 saatte düzeltilecek şekilde sıvısı ayarlandı. Başvurunun 48. saatinde solunumu yüzeyselleştiği için entübe edildi. Anne sütü sodyum içeriği yüksekti. Batın USG, kranial MRG, amonyak, laktat, idrar organik asit ve kan aminoasit düzeyi normal idi. Postnatal 30. günde sepsis ve multiorgan yetersizliğinden kaybedildi. Her sağlık kuruluşunun anne sütüne bağlı dehidrasyonu önlemede standart bir protokol oluşturması, mortalite ve morbiditeyi önlemede basit ve etkili bir yöntem olduğunu düşünmekteyiz.

Severe hypernatremic dehydration in neonatal period

We would like to emphasize the importance of causes and clinical outcomes in a neonate with severe hypernatremic dehydration due to early discharged inadequately breastfed infants. A 15 day old female infant presented with sucking difficulty, a tendency to sleep and a decrease in movements. In her physical examination; turgor and tonus were decreased, axillary body temperature 36.70C, heart rate 180/minute, breathing per minute 40/minute, arterial tension 40/20 mmHg, weight 2170 g (30% weight loss). The other systemic examination was in the normal range. She had Na 187meq/L, creatinine 3,9 mg/dl, glucose 220 mg/dl and she was in metabolic acidosis. The other biochemical and hormonal values were normal. A parenteral rehydration was performed to correct her deficit and she was monitored for 72 hours. After 48 hours of hospitalisation, she was intubated because of breathing difficulty. The sodium value was high in mother's breast milk. Abdominal USG, kranial MRG, ammonium, lactate, urinary organic acid and blood aminoacid levels were normal. At postnatal 30th day she died due to sepsis and multiorgan failure. Every health organisation must have a standard way to prevent dehyration due to breastfeeding. This is an important, effective and simple way of preventing morbidity and mortality.

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