Hypernatremic dehydration occurs in neonates because of inadequate breastfeeding in an exclusively breast fed baby. Though hypernatremia due to insufficient breast feeding is an infrequent entity the incidence is on the rise. Hypernatremic dehydration should always be kept in the differential diagnosis of exclusively breastfed babies who present with more than expected weight loss, refusal to feed, lethargy, jaundice, seizures or decreased urine output. Here we present 3 term neonates, in the first three weeks of life, who presented with more than physiological weight loss and severe dehydration, whose initial serum sodium levels were above 170mEq/l. With institution of appropriate fluid protocol as per unit policy serum sodium levels gradually came down in next 72 hours. After complete work-up we came to the conclusion that breast milk was the source of high sodium load for the babies. Therefore, awareness and early recognition of this potentially fatal but treatable clinical condition is desirable for favorable outcomes in newborn babies.
