No, unfortunately severe hypernatremic dehydration is not uncommon.
Death is unusual, but we had a couple of deaths in the Toronto area last
year.

The reason the mother's milk has a high sodium is that the baby was
*not* breastfeeding and the involution of breast resulted in a high
sodium milk (see Lawrence).  It is *not* the high sodium which causes
the hypernatremia.  When babies drank straight cow's milk, they did not
get hypernatremic unless they also started getting diarrhea or vomiting
while drink it.  Unfortunately pediatricians interpret the data as
"salty milk syndrome".  IDIOTS.  Idiots, because they are completely
beside the point, and thus will not do anything to remedy the problem.
The remedy is *prevention*.

This is the problem of the baby who refuses the breast while not
actually fighting it.  He allows the breast into his mouth, but does not
latch on and does not get milk.  At first the baby cries when coming off
the breast, but as he gets drier and drier, he sleeps and the mother
thinks things are actually getting better when in fact they are getting
worse.  This has been said to be due to insufficient milk supply but I
reject that interpretation completely.  (See my article in JHL June
1996).

The worst thing about this is that the problem could be prevented 100%
of the time, even if the mother did not produce a single drop of milk.
We need nurses in postpartum who have the knowledge and skills to help
new mothers.  We need automatic followup of all breastfeeding babies 24
to 48 hours after discharge from hospital.  But there is no point in the
baby being seen by a pediatrician or family physician, unless they know
something more than most about breastfeeding.

God, when will those responsible for health care understand that
breastfeeding is not a life style issue but a question of life or death?
That nurses working in postpartum can't just transfer over from
geriatrics and be postpartum nurses.  They have to know how to evaluate
the adequacy of breastfeeding, and they need to know when to get help.

Jack Newman, MD, FRCPC