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Old 09-18-2012
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Default Case of Asymptomatic severe hyponatremia

A 52-year-old man is recovering in the surgical
intensive care unit from a total colectomy for
colorectal adenocarcinoma 1 day earlier. He
has one peripheral intravenous line that is being
used to run a patient-controlled analgesia
pump, 0.5 normal saline at 86 mL/hr, and cefazolin.
He has no complaints, appears well,
and is conversational. Relevant laboratory fi ndings
are a serum sodium level of 110 mEq/L;
his sodium level was 137 mEq/L 1 day earlier.
What is the best next step in the management
of this patient?

(A) Discontinue cefazolin
(B) Discontinue patient-controlled analgesia
pump
(C) Draw blood for testing from the other arm
(D) Restrict fl uid intake
(E) Switch to hypertonic saline infusion
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Old 09-18-2012
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ans ........C...........
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Quote:
Originally Posted by Hitman View Post
ans ........C...........
reason plzzzz
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Old 09-18-2012
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why not D? i dont think it's safe to admin hypertonic solution.
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(C) Draw blood for testing from the other arm
Patient should have neurological symptoms (due to acute hyponatremia) which he doesn't.
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The correct answer is C. This patient has a
dangerously low serum sodium value but no
apparent symptoms of hyponatremia (confusion,
stupor, seizures). Therefore, it is likely
that this value is spurious. This is a common
occurrence in patients who are phlebotomized
in the same arm as the intravenous infusion,
proximal to the catheter site.
Answer A is incorrect. There is no association
between intravenous cefazolin and hyponatremia.
Answer B is incorrect. Patient-controlled analgesia
pumps are not a signifi cant source of free
water and are unlikely to contribute to hyponatremia.
Answer D is incorrect. Fluid restriction is the
appropriate treatment for mild, asymptomatic
hyponatremia (sodium <120 mEq/L). However,
it is important to ensure the hyponatremia
is real before initiating treatment.
Answer E is incorrect. Hypertonic saline can
be used for the treatment of severe, symptomatic
hyponatremia. In severe cases (seizures),
correction should not exceed 1.5–2 mEq/hr,
especially if hyponatremia has been long standing.
Too-rapid correction of the hyponatremia
can result in central pontine myelinolysis. This
patient does not have true hyponatremia, so
correction is not warranted.
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