Hypernatremic dehydration in children

master's thesis

• Title (croatian): Hipernatremijska dehidracija u djece
• Author: Narindra Zoantsoa Ramanantseheno
• Mentor: Mario Ćuk (mentor)
• Committee member: Mario Ćuk (predsjednik povjerenstva)
• Committee member: Danko Milošević (član povjerenstva)
• Committee member: Marija Jelušić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Pediatrics); Zagreb
• Defense date and country: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Pediatrics

Abstract

OBJECTIVE: The objective of this paper was to provide a literature review on hypernatremic dehydration (HND) in children and the role of Charts, which are based on weight loss with Standard Deviation Score (SDS), in its management. Before this condition can be treated, it is important to assess the weight loss by the patient. Charts based on weight loss with SDS have been established by a case-control study to diagnose HND. The vast majority of children with already present or developing HND fell below the -1 SDS line at day 3, the -2 SDS line at day 4, and the -2.5 SDS line at day 5. Therefore, charts for weight loss can be helpful in early diagnosis of HND and in its prompt management plan. ----- METHODS: The key terms of hypernatremic dehydration in children, management of hypernatremic dehydration and breast-feeding were searched on Pubmed and the literature available under these terms was reviewed and summarized in this paper, and a clinical case is presented to demonstrate HND due to problem in initiation of breastfeeding. ----- DISCUSSION: The problem of HND is recurrent in the hospital setting but also represents a common issue in breastfed infants. It is normal over the 1st week of life for the neonate to lose as much as 7% of its birth weight through normal diuresis, but then should start to gain weight thereafter. Rapid weight loss > 7% of birth weight is the most obvious sign of neonatal dehydration due to HND with symptoms of decreased bowel movements, decreased urination, dry mucous membranes, sunken fontanel, poor skin turgor, and lethargy. Therefore, routine weight monitoring is universally proposed for the early detection and management of HND. The poor initiation of breastfeeding can lead to development of HND in infants, which besides the clinical assessment of the newborn also requires the educational preventive measures. ----- CONCLUSION: The monitoring of weight loss in children along with clinical presentation can help in diagnosis of HND, and subsequently proper management. To avoid serious morbidity and mortality, all breastfed infants should receive regular follow-up by health-care workers.

Abstract (croatian)

CILJ: Cilj ovog rada je prikazati pregled literature o hipernatrijemijskoj dehidraciji (HND) u djece, i ulogu Charts, koje su utemeljene na gubitku težine sa skorom standardne devijacije (SSD), u liječenju. Prije započinjanja liječenja bitno je procijeniti gubitak težine u pacijenta. Chart su utemeljene na gubitku težine sa SSD su potvrđene u case control studiji za dijagnozu HND. Velika većina djece sa već prisutnim ili razvijajućim HND pada ispod -1 SSD linije u trećem danu, -2 SSD linije u četvrtom i -2,5 SSD linije u petom danu. Stoga, charts za gubitak težine mogu biti od pomoći u ranom dijagnosticiranju HND te u brzom stvaranju plana postupanja. ----- METODE: Ključne riječi o HND u djece, menadžmentu HND i dojenju su pretražene na PubMed-u i literatura dostupna pod tim riječima je pregledana i sažeta u ovom radu. Dodatno, prezentiran je klinički slučaj za demonstraciju HND uslijed problema u započinjanju dojenja. ----- DISKUSIJA: HND kao problem je ponavljajući u bolničkom okruženju, ali također predstavlja čest problem u dojenčadi. Za novorođenčad je u prvom tjednu života normalno izgubiti do 7% porođajne težine kroz normalnu diurezu, međutim nakon toga ubrzo trebaju dobiti na težini. Brzi gubitak više od 7% porođajne težine je najočitiji znak novorođenačke dehidracije zbog HND-a sa simptomima smanjenog broja stolica smanjenog mokrenja, suhih sluznica, uvučenih fontanela, smanjenog turgora kože i letargije. Stoga, rutinsko mjerenje težine se univerzalno predlaže za ranu detekciju i liječenje HND-a. Sporo započinjanje dojenja može voditi do razvoja HND-a u novorođenčadi, što pored kliničke procjene novorođenčadi također zahtijeva edukacijske preventivne mjere. ----- ZAKLJUČAK: Praćenje gubitka težine u djece zajedno sa kliničkom prezentacijom može pomoći u ranoj detekciji HND-a, a shodno tome i adekvatnom liječenju. Da bi se izbjegli ozbiljan morbiditet i mortalitet, sva dojenčad trebaju biti adekvatno i redovno praćena od strane zdravstvenih radnika.

• Keywords: hypernatremic dehydration; metabolic acidosis; initiation of breastfeeding; management of hypernatremic dehydration; charts for weight loss monitoring
• Keywords (croatian): hipernatrijemijska dehidracija; metabolička acidoza; započinjanje dojenja; liječenje hipernatrijemijske dehidracije; charts za praćenje gubitka težine
• Language: english
• URN:NBN: urn:nbn:hr:105:195054
• Study programme: Title: Medicine (in English language); Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2020-07-23 09:19:25