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Date: | Thu, 5 Jul 2007 10:38:52 -0400 |
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An unresponsive/extremely lethargic baby who has been getting little
milk for several days to a week could have hypernatremic dehydration,
which is a medical emergency, and does not present with typical signs of
dehydration (baby looks good physically until things are critical, then
crashes). There is an alternate form of metabolism that happens in
infants who don't get sufficient food, they produce ketone bodies from
fat breakdown, which help retain water in the brain as well as provide
an alternate fuel source for the brain cells. If the baby runs out of
fat to provide this fuel before he gets more food, it can be
catastrophic very quickly (infants have had strokes and other problems).
Infants with hypernatremic dehydration need to be re-fed carefully.
Feeding should be increased gradually under constant medical
supervision. If the baby is given a lot of fluid, the brain can swell
(because of how efficient the ketones are at holdign water) and that can
cause brain damage. They need to switch metabolism to burning glucose
again, digest all the ketones, and then they can be fed large quantities.
It's usually safe to feed a small quantity of expressed milk from his
mom (to see if the calories perk him up and protect him from running out
of energy on the way to the hospital) if that will not unduly delay
getting medical assistance.
Again, if this baby has this condition, he needs to be in hospital.
Catherine Watson Genna, IBCLC NYC
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