1 Department of Pharmacy, CHU Sainte-Justine, Montreal, Canada .
2 Department of Pediatrics, CHU Sainte-Justine, University of Montreal , Montreal, Canada .
Breastfeed Med. 2017 Jul/Aug;12(6):377-380. doi: 10.1089/bfm.2017.0031. Epub 2017 May 8.
Hypernatremic dehydration is well described in exclusively breastfed neonates, although life-threatening complications are rarely reported.
The present article describes a case of severe hypernatremic dehydration in a previously healthy term neonate. Other published cases of severe complications of hypernatremic dehydration are discussed.
The exclusively breastfed neonate described had severe hypernatremic dehydration because of inadequate milk intake, with disseminated intravascular coagulation and right lower limb gangrene that required amputation of all five toes and surgical debridement of the metatarsals. The usual etiology of hypernatremic dehydration in this age group is insufficient breast milk intake. Here, the infant's mother was treated for bipolar disorder with lamotrigine 250 mg orally once daily, aripiprazole 15 mg orally once daily, and sertraline 100 mg orally once daily.
Awareness of these complications should prompt close follow-up of the infant with poor weight gain. The role of maternal medication as a risk factor for hypernatremic dehydration among exclusively breastfed infants needs to be further explored.
尽管鲜有危及生命的并发症报道，但仅母乳喂养的新生儿中高钠血症性脱水已有明确描述。
本文描述了一例此前健康的足月新生儿重度高钠血症性脱水病例。同时讨论了其他已发表的重度高钠血症性脱水并发症病例。
所描述的仅母乳喂养的新生儿因摄入不足的母乳而发生严重高钠血症性脱水，伴有弥散性血管内凝血和右下肢坏疽，需要对所有五个脚趾进行截肢和跖骨清创手术。该年龄段高钠血症性脱水的常见病因是母乳摄入不足。在这里，婴儿的母亲因双相情感障碍接受治疗，每日口服拉莫三嗪 250mg、阿立哌唑 15mg 和舍曲林 100mg。
认识到这些并发症后，应密切关注体重增长不良的婴儿。需要进一步探讨母亲用药作为仅母乳喂养婴儿高钠血症性脱水的危险因素的作用。
