>Can anyone answer a question for me?  Is it possible for a baby 
>wiith severe hypernatraemic dehydration, say with nearly 25% weight 
>loss, to be passing normal quantities of normal urine?  Thus 
>throwing to the winds the normal advice for a mother to count wet 
>nappies/diapers as a way to know her baby is  taking in enough 
>breastmilk.  I've just heard of 2 such cases and I'm wondering what 
>could have happened.
>
>This really bothers me because it seems so unlikely and I've been 
>asked to comment to a healthcare professional.
>
>My knee-jerk reaction would be to think that a baby breastfeeding so 
>seldom, or so infrequently as to have become dehydrated might 
>suddenly have been fed a large quantity of formula, so causing 
>hypernatraemia.
>
>Can anyone come up with a likely explanation??
>
>Many thanks if you can help.
>
>Pamela Morrison IBCLC
>Rustington, England


My understanding is that not urinating is a very late stage - I have 
come across a number of babies who were admitted for HD, with serious 
weight loss, and it was only the one with the massive weight loss 
(sticks in my mind because I wrote her up as a formal case study) 
where there was noticably less urine.

I have come across a number of mothers who were worried about the 
baby's intake, and were told 'as long as he is weeing, he is fine' 
and the babies were *not* *fine*.

I think one issue is that it is impossible with today's 
super-absorbent nappies to estimate urine loss - the trick of putting 
in a cloth or a cotton wool ball inside to show up urine loss helps a 
bit, but I have no idea how this would be counted in 'voids'.  Two or 
three urinations could happen in between nappy changes!

It's sensible I think to watch for a 'heavy' nappy - in the sheet I 
co-wrote for NCT on 'what's in a nappy?' we encourage mothers to look 
for 'heavy' nappies, and to test what one should feel like by placing 
water from a spoon into a dry nappy and then lifting it. I am sure 
hardly anyone would do this though ;)

All the babies with HD treated in hospital have had the same symptom 
though - lack of stooling.  And this is easy to spot, and easy to 
monitor by counting.

Lack of stooling happens before lack of urination.

  Heathetr Welford Neil
NCT bfc, tutor, UK

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