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?
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?
💡 Explanation
## **Core Concept**
The patient's clinical presentation and laboratory findings suggest a diagnosis of **hyponatremia** and **hypokalemia**, likely due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) or cerebral salt wasting, but more commonly seen in this context is **hyponatremic encephalopathy** likely due to **excess free water** administration.
## **Why the Correct Answer is Right**
The patient received 5% dextrose in 0.5% normal saline solution at a rate of 125 mL/h. The solution provides approximately 30-40 mEq of sodium per liter, which is less than the body's daily sodium needs and significantly less than what is lost in urine and nasogastric drainage. The patient's serum sodium level dropped to 130 mEq/L, and he developed symptoms of hyponatremia, including somnolence progressing to deep coma and seizures. This scenario is consistent with **acute hyponatremic encephalopathy**, a medical emergency. The urine electrolytes show a high sodium level (61 mEq/L), indicating that the kidneys are appropriately trying to conserve sodium, but the amount of free water being administered is excessive.
## **Why Each Wrong Option is Incorrect**
- **Option A:** Not provided, thus cannot be evaluated.
- **Option B:** Not provided, thus cannot be evaluated.
- **Option C:** Not provided, thus cannot be evaluated.
- **Option D:** Not provided, thus cannot be evaluated.
## **Clinical Pearl / High-Yield Fact**
A key point to remember is that **hyponatremic encephalopathy** is a life-threatening condition requiring immediate treatment. In symptomatic hyponatremia, especially with seizures, **hypertonic saline (3% NaCl)** is often administered to rapidly increase serum sodium levels. The goal is not to correct the sodium level completely but to alleviate symptoms.
## **Correct Answer: D.**
✓ Correct Answer: C. A small qantity of hypeonic saline to be given
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