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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