Below are my thoughts about sodium in Neonatal PN:
1-Premature neonates often have unstable electrolyte requirements. To the best of my knowledge there is no reference stating the ceiling doses of electrolytes in PN.
2-Maintenance requirement of sodium 2-6 mmol/kg
3-Adjustment of sodium in PN is based on patient assessment. Patient may require 8-12 mmol/kg of sodium as acetate or chloride.
4-It’s vitally important to identify underlying cause before increasing Sodium in PN.
5-Factors that may increase sodium requirements include: Prematurity, Renal sodium loss from a high fractional excretion of sodium, Excessive water intake, Excessive maternal fluid intake during delivery. Diuretic therapy, especially loop diuretics. Acute tubular necrosis (tubular sodium loss) and other causes of renal failure. Excess sodium loss: Diarrhea, Gastric, pleural, CSF)
6-Whenever possible the underlying cause should be treated, rather than just treating the serum sodium concentration.