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  #1  
Old 01-09-2011
dr-ahmed's Avatar
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Kids Confusing Pediatric Question

Three year old boy has been followed for three days because of diarrhea that has been worsening. The pediatrician has instructed that he receives clear liquids only. On the fourth day, the mother takes the boy to the ER because he has become more irritable and lethargic. Upon evaluation he's found to be severely dehydrated. Wt. 20 Kg, HR 120, Systolic BP 70. His serum Sodium concentration 173 meq/l. He was given 400 ml of normal saline over 30 minutes. He required another 20 ml/kg normal saline for his vitals to normalize. How should his remaining fluid therapy be given?

A) Give the entire maintenance plus deficit equally over 24 hours.
B) Give the maintenance and solute deficit over the first 24 hours with half the free water deficit, then maintenance and the other half of the free water deficit over the next 24 hours.
C) Give the maintenance over 24 hours, half the deficit over the first 8 hours and the remaining deficit over the next 16 hours.
D) Give the maintenance with half the solute deficit over the first 24 hours; then the maintenance, the other half of the solute deficit, and the entire free water deficit over the next 24 hours.
E) Give the maintenance with the solute deficit and free water deficit equally over 48 hours.
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  #2  
Old 01-12-2011
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I think the correct answer is E, that's how we should treat hypernatremia
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Old 01-12-2011
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Default B

That would be my best shot
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Old 01-12-2011
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Default What's the concept ??

I don't need the right answer as much as I need to know the concept behind it ,, why the right answer here is right and why the rest of the answers are wrong ,, ??!!!!

Thanks for your efforts guys
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Old 01-12-2011
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Default I think B is the answer

Correct answer is B.

In hypernatremia you replace 50% of the water deficit over 12-24 hours and then you replace the remaining 50% over the next 24 hours.

The issue is that rapid correction may lead to cerebral edema and therefore you have to be very careful.

The question mentioned that the intravascular volume has been already restored as the vitals returned to normal and so we don't need to care about in the next phase of our treatment.
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Old 01-13-2011
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The question is a bit wrong I guess. Pt shouldn't have developed that high hypernatremia. Because the doctor ordered hypotonic fluids p.o the child should had been a little less hypernatremic don't you think? I don't have the clinical experience but thats what my logic tells me. What do you think guys?
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Old 01-14-2011
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yes, i agree with sabio. they never give the whole quantity once because of cerebral edema development. The 1st infusion is to hemodynamically stabilize the pt. and then to restore the deficit.
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