A 64-years-old previously healthy man is admitted to to a hospital because of a closed head injury and ruptured spleen Following a road side accident following an automobile accident. During the first 4 days of hospitalization, following laparotomy and splenectomy, he receives 5% dextrose 0.5% normal saline solution at a rate of 125 mL/h. Recorded daily fluid outputs include 450 to 600 mL of nasogastric drainage and 700 to 1000 mL of urine. The patient is somnolent but easily aroused until the morning of the 5th hospital day, when he noted to be in deep coma. By the after-noon, he begins having seizures. The following laboratory data are obtained: Serum electrolytes (meq L): Na+130: K+1.9; CI 96; HC03 19.Serum osmolality: 260 mOsm/L; Urine electrolytes (meq/L):Na+ 61; K+18. Which of the following statements about diagnosis or treatment of this patient’s condition is TRUE?
Correct Answer: A small qantity of hypeonic saline to be given
Description: Patient in the question has developed coma secondary to hyponatremia, so the best treatment of choice in this patient is to give a small quantity of hypeonic saline. In general, if hyponatremia has developed rapidly (over hours to days), morbidity due to cerebral edema is more likely, and is generally safe to correct the plasma sodium relatively rapidly. This can include infusion of hypeonic (3%) sodium chloride solutions, especially when the patient is obtunded or convulsing. Hyponatremia (plasma Na < 135mmol/L) is a common electrolyte abnormality, it is often asymptomatic but can also be associated with profound disturbance of cerebral function, manifesting as anorexia, nausea, vomiting, confusion, lethargy, seizures and coma. The degree of cerebral symptomatology depends more on rate of development of electrolyte abnormality than on it's severity. Ref: Davidson's Principles and Practice of Medicine, 21st Edition, Page 436
Category:
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