Severe Hypernatremic Dehydration and Lower Limb Gangrene in an Infant Exposed to Lamotrigine, Aripiprazole, and Sertraline in Breast Milk

Morin, Caroline; Chevalier, Isabelle

doi:10.1089/bfm.2017.0031

Cited by 14 publications

(8 citation statements)

References 17 publications

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“…In neonates and young infants on exclusive breastfeeding, occurrence of peripheral gangrene was also linked to hypernatraemic dehydration resulting from inadequate fluid intake. 4,12 As explained by Kotbyet al 2 , dehydration causes hypovolaemia and haemoconcentration, which can precipitate hyperviscosity. The latter results in stasis that may lead to hypercoagulable state and tendency for thrombus formation.…”

Section: Discussionmentioning

confidence: 98%

Left lower Limb Gangrene Following Diarrhoeal Disease and Dehydration in a child with Transposition of the Great Arteries

Sani¹

2017

jmscr

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Section: Discussionmentioning

confidence: 98%

Left lower Limb Gangrene Following Diarrhoeal Disease and Dehydration in a child with Transposition of the Great Arteries

Sani¹

2017

jmscr

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“…Common causes of gangrene in neonates are sepsis, dehydration, maternal diabetes, indwelling arterial or venous catheter, vasculitis, hypernatremic dehydration, polycythemia, syphilis, cold exposure, hyperglycemia, asphyxia, intravenous hyperosmolar infusion, hereditary thrombotic disorders, antiphospholipid antibody syndrome, congenital heart defect, and neonatal diabetes mellitus [6][7][8][9][10][11][12]. Our patient had severe hypernatremic dehydration secondary to inadequate feeding.…”

Section: Discussionmentioning

confidence: 99%

“…Gangrene in neonates occurs rarely, but it has serious consequences [4][5][6]. Common causes of gangrene in neonates are sepsis, dehydration, maternal diabetes, indwelling arterial or venous catheter, vasculitis, hypernatremic dehydration, polycythemia, syphilis, cold exposure, hyperglycemia, Tamene et al Maternal Health, Neonatology and Perinatology (2022) 8:5 asphyxia, intravenous hyperosmolar infusion, hereditary thrombotic disorders, antiphospholipid antibody syndrome, congenital heart defect, and neonatal diabetes mellitus [7][8][9][10][11]. However, in the majority of cases, an etiological factor is not identified [2,6,12].…”

Section: Introductionmentioning

confidence: 99%

Nasolabial and distal limbs dry gangrene in newborn due to hypernatremic dehydration with disseminated intravascular coagulation: a case report

Tamene

Anteneh

Amare

et al. 2022

matern health, neonatol and perinatol

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Introduction Gangrene is the death of an organ or tissue due to lack of blood supply or bacterial infection. In neonates, gangrene is usually caused by sepsis, dehydration, maternal diabetes, asphyxia, or congenital anticoagulant deficiency. It commonly occurs in the extremities. Gangrene may lead to death or amputation of the limb. Early diagnosis and prompt management of the underlying cause halts the progression of the disease. Case presentation A 12-day-old neonate presented with a complaint of black discoloration of the nose and feet for 2 days. He was breastfeeding poorly and had signs of dehydration. Upon physical examination, he was tachycardic (pulse rate = 182 beats per minute), tachypneic (respiratory rate = 62 breaths per minute), and hypothermic (temperature = 35.0 oC). He lost 33.3% of his birth weight. He had demarcated cold, dry, and dark discoloration of the entire nose, nasal septum; upper lip; palate; bilateral distal lower limbs; and the left fifth finger. Dorsalis pedis arteries were not palpable on either side. On investigation, the baby had pancytopenia, hypernatremia, elevated creatinine, elevated coagulation profiles, and absent arterial flow in bilateral dorsal pedis arteries. He was treated for hypernatremic dehydration and possible sepsis. He was transfused with whole blood, platelets, and fresh frozen plasma, but finally, the patient passed away on the 7th day of admission. Conclusion The entire nose, upper lip, soft and hard palate, symmetric lower limb, and fifth finger gangrene due to severe hypernatremic dehydration complicated by disseminated intravascular coagulation may occur in the same patient. To avoid such serious neonatal problems, mothers should be properly educated about optimal breastfeeding techniques and schedule well-child visits 3–5 days after birth.

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“…There are very few reports to date highlighting limb gangrene as a consequence of hypernatremia. Morin and Chevalier reported a case of an exclusively breastfed neonate with severe hypernatremic dehydration presenting with disseminated intravascular coagulation and right lower limb gangrene requiring amputation of all five toes and surgical debridement of the metatarsals secondary to inadequate feeds [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Femoral Artery Thrombosis: Rare Sequelae of a Common Entity

Rawat¹,

Lakhkar²,

Karotkar³

et al. 2022

Cureus

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Neonatal hypernatremic dehydration (NHD) is a common complication in breastfed neonates which if not recognized early can lead to life-threatening complications. Only a few cases of NHD leading to peripheral gangrene have been reported in the literature. We report a case of a 14-day-old neonate with complaints of dyspnoea, poor oral intake, and gangrenous changes in the left leg. There was a 28% weight loss since birth due to inadequate feeding. The baby was diagnosed with severe hypernatremic dehydration with Kidney Disease Improving Global Outcomes (KDIGO) stage 4 acute kidney injury requiring peritoneal dialysis. Ultrasonography of the left lower extremity revealed a distal femoral artery thrombus leading to dry gangrene requiring amputation. There were neurological signs like altered sensorium and drug-resistant seizures which were suspicious for intracranial pathology like cerebral venous sinus thrombosis. Prevention and early diagnosis of NHD are essential to prevent the occurrences of such grave complications. It can be easily achieved by improving the vigilance regarding the adequacy of feeds subjectively by the mother if the baby is at home and objectively by physicians in the hospital setting. These simple interventions have the potential to prevent readmissions due to not only simple feeding complications but grave complications as mentioned above as well and save precious lives.

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Severe Hypernatremic Dehydration and Lower Limb Gangrene in an Infant Exposed to Lamotrigine, Aripiprazole, and Sertraline in Breast Milk

Abstract: Awareness of these complications should prompt close follow-up of the infant with poor weight gain. The role of maternal medication as a risk factor for hypernatremic dehydration among exclusively breastfed infants needs to be further explored.

Cited by 14 publications

References 17 publications

Left lower Limb Gangrene Following Diarrhoeal Disease and Dehydration in a child with Transposition of the Great Arteries

Left lower Limb Gangrene Following Diarrhoeal Disease and Dehydration in a child with Transposition of the Great Arteries

Nasolabial and distal limbs dry gangrene in newborn due to hypernatremic dehydration with disseminated intravascular coagulation: a case report

Femoral Artery Thrombosis: Rare Sequelae of a Common Entity

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