Rasul
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Pt with Alzheimer, t=102F, BP 95/55mmHg, Ps 89bpm, Sa=92%. CXR-right side middle lobe-pneumonia(probably aspiration), changed level of consciessness(non-verbal compared to status 2 weeks ago), no focal symptoms. CTscan of the head -unremarkable.Sodium level-125mEq/L. Pt is started on 0.9% NaCl sol 500cc/hr for 5 hrs.
This pt is at the risk of which of following conditions:
1. CVA
2. acute uncal herniation
3. acute pontine myelinolysis
4. internuclear ophthalmoplegia
5. spasmatic torticollis
Kaplan suggests the answer:acute pontine myelinolysis(complication due to trial of rapid sodium level recovery, e.g. infusion of 3% sol of NaCl). What I cannot understand is: why? Aren't we supposed to use 0.9% sol for hypovolemic hyponatremia correction? I think everything is correct and Pt is not at risk of anything! Or am I wrong?
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| achilles
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hi rasul, giving 0.9% sol to a hyponatremic patient as a treatment also has its risks...if the solution is giving too quickly then the patient might develop pontine myelinolysis which is an irreversible condition...it is a complication if this treatment is given too quickly...the rate of correction should not be more than 12meq/day.
if the patient has seizures, severe confusion, coma, signs of brain stem herniation, then initially the rate of correction can be fast until 4-5meq correction has been done. electrolytes have to be measured every 2-4 hrs to avoid overcorrection or rapid correction and then the specified rate has to be followed. the ultimate danger for patients of hyponatremia is brain stem herniation which is seen in patients with Na < 120meq/L
normal saline(0.9%) and hypertonic(3%) both raise the serum sodium as patients serum Na is less that normal salline Na conc. and its the rate of correction which can be dangerous for the patient.
the treatment is not wrong, and this is what we have to do but it has to be given very carefully otherwise the patient is at risk of developing central pontine myelinolysis.
hope i answered your question in the context that you asked.
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| Rasul
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Thank You, Achilles. You did answer in the context I've asked. So, the rate of Na correction is still high. Thanks again.
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| achilles
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Topics: 88
Posts: 1,221
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yup...its a very high rate...a litre of normal saline contains 154meq/L and of hypertonic saline contains 500meq/L...so you can just see how fast that rate is considering that the correction should not be more than 12meq/day.
___________________
" it's not whether you get knocked down, it's whether you get up"
" i have miles to go before i sleep "
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