02-17-2017, 10:08 AM
A 24-year-old patient is being evaluated for a declining sodium level. Four days ago the patient
suffered a subarachnoid hemorrhage from a ruptured berry aneurysm. The hemorrhage was
evacuated and the aneurysm clipped, and the patient has slowly recovered. He is now in guarded but stable condition on the neurosurgical ward. His plasma sodium, however, has decreased from 138 mEq/dL to 130 mEq/dL, then to 128 mEq/dL. The patient has been mildly fluid restricted to 1.5 L/day, which seems to have slowed the rate of sodium decline. Given the risk for ostoperative vasospasm and cerebral hypoperfusion, however, further fluid restriction is not possible. The patient seems clinically euvolemic but has fairly concentrated urine, manifested by a high urine osmolality and specific gravity. Urine studies also reveal salt wasting, with an elevated total urinary sodium level and elevated fractional excretion of sodium. A review of the patient™s laboratory studies is remarkable only for a low uric acid level.
If this patient™s sodium continues to decrease, which of the following is an appropriate
intervention?
A. 1/2 normal saline
B. D5 water bolus
C. Demeclocycline
D. Desmopressin
E. Normal saline
suffered a subarachnoid hemorrhage from a ruptured berry aneurysm. The hemorrhage was
evacuated and the aneurysm clipped, and the patient has slowly recovered. He is now in guarded but stable condition on the neurosurgical ward. His plasma sodium, however, has decreased from 138 mEq/dL to 130 mEq/dL, then to 128 mEq/dL. The patient has been mildly fluid restricted to 1.5 L/day, which seems to have slowed the rate of sodium decline. Given the risk for ostoperative vasospasm and cerebral hypoperfusion, however, further fluid restriction is not possible. The patient seems clinically euvolemic but has fairly concentrated urine, manifested by a high urine osmolality and specific gravity. Urine studies also reveal salt wasting, with an elevated total urinary sodium level and elevated fractional excretion of sodium. A review of the patient™s laboratory studies is remarkable only for a low uric acid level.
If this patient™s sodium continues to decrease, which of the following is an appropriate
intervention?
A. 1/2 normal saline
B. D5 water bolus
C. Demeclocycline
D. Desmopressin
E. Normal saline