By Richard Arthur Preston
Univ. of Miami, FL. Concise instruction manual on fixing difficulties touching on advanced fluid, electrolyte, and acid-base issues. For clinical scholars, interns, citizens, nurses and nurse practitioners, and first-year nephrology fellows. Softcovers.
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Additional resources for Acid-Base, Fluids, and Electrolytes Made Ridiculously Simple (1st Edition)
A patient presents with polyuria and polydipsia and altered mental status. On physical examination, the patient is poorly responsive. There is poor skin turgor and a blood pressure drop from 100184 to 80162 on sitting, with a pulse increase from 92 to 128. Laboratory studies show: glucose 2100 mgldl, sodium 130 mEq/L, and blood urea nitrogen 40 mgldl. The measured osmolality is 395 mOsm/L. What is the cause of the hyponatremia in this patient, and what is the serum sodium once it has been "corrected" for the elevated glucose?
Write "maintenance" IV orders for a 50 kg woman who will be kept NPO for 24 hours for tests. No renal, cardiac, or liver disease. No recent or future surgery. The patient has no medical condition and is taking no medication listed in Figs. 3-1 or 3-2 which could produce hyponatremia with hypotonicity. Amount of water per day: approximately 2000-2500 cc (for this case, say 2000 cc). Amount of sodium per day: approximately 50-100 mEq (for this case, say 50 mEq1day). Amount of potassium per day: approximately 20-60 mEq (for this case, say 40 mEq).
5 mEq/L (or less) per hour. An increase of the sodium concentration of 6-8 mEq/L should be enough to reduce symptoms acutely. Once symptoms improve, the 3% saline should be slowed/stopped. Permit no more than 10-12 mEq/L increase in sodium concentration in the first 24 hours. 50-100 mVhr of 3% saline initially is generally safe for a brief period in a severely symptomatic "average" sized person, until appropriate calculations can be done to determine a more precise rate of administration. Be very careful in women and in chronically ill patients, such as alcoholics, cancer patients, and patients who have had a recent cardiac arrest because these patients are at risk for ODs.