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Discussion Starter · #1 ·
In hypovolumic hypernatremia ....
Kaplan both in book and qbank said : give 5% dextrose and half(.45%) normal saline .... here in ques its due to excessive diuresis .. than intake ... hypo hyperNa
In UW : normal (.9%) saline is fluid of choice for initial Rx ... here due to diarrhea in a child ....
Tho both are are hypovolumic HyperNa
So i am confused cause ... can someone please explain this thing ... thank u
 

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I think that first of all we have to assess hypovolemia. If there are true signs of hypovolemia, I think that this topic should be addressed first, because correcting the extracellular fluid volume will lead to correction of sodium concentration. So, in a pt with apparent signs of hypovolemic shock I would administer normal saline.

If the pt is euvolemic (and even worse hypervolemic), there is a considerable risk of volume overload, which would secondarily lead to edema (pulmonary, anasarca, heart congestion etc). In this case, I think the appropriate management should involve D5W & 1/2NS, in order to cause osmotic diuresis & consequent natriuresis at the same time.
 

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Discussion Starter · #3 ·
I have got a answer in UW about this ques and it really make sense ...
1. If hypernatremia with hypotension ... best initial .9 % nacl ... and when pt stabilize start .45% nacl
2. If hypernatremia without hypotension .... best initial is .45 % nacl

U r right ath.pentelis .... best initial depends on volumia either hypo or eu ...
 
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