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Why not hypertonic saline??????? - vatsalshruti
#1
1. A previously healthy 52-year-old man comes to the emergency department because of hiccups for 1 week. He has smoked two packs of cigarettes daily for 30 years. He does not drink alcohol. He is alert and oriented. His temperature is 37 C (98.6 F), blood pressure is 150/95 mm Hg, pulse is 70/min, and respirations are 12/min. Physical and neurologic examinations show no abnormalities. His serum sodium level is 120 mEq/L. An x-ray film of the chest shows a right hilar mass. Which of the following is the most appropriate next step in treatment?

A
) Bisphosphonate therapy

B
) Calcitonin therapy

C
) Calcium therapy

D
) Dexamethasone therapy

E
) 5% Dextrose in 0.225% saline therapy

F
) 5% Dextrose in 0.45% saline therapy

G
) 5% Dextrose in water therapy

H
) Fluid restriction

I
) Hydrocortisone therapy

J
) Lactated Ringer's solution

K
) Mannitol therapy

L
) Potassium therapy

M
) 0.9% Saline therapy

N
) 3% Saline therapy

O
) Sodium bicarbonate therapy
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#2
Hypertonic saline is for very severe hypona+
ver severe means lethargy , seizure and coma
Mtb 2 pg 332
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#3
M) The Patient is stable shows that the process of SIADH secretion has been chronic and it should be treated slowly.Agressive treatment with hypertonic saline causes central pontine myelinelysis syn!
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#4
@ residencytrial, uburger ,

Thanks a lot 4 exp...

I've posted some other doubts. Plz guys give ur inputs...
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#5
WHY NOT....H...
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#6
@raheem, thanks for joining us..

I just read the previous discussion of amirh on this & he explained for H- fluid restriction

I've read in UW- SIADH mild-fluid restriction

moderate- NS

severe- hypertonic saline

As the pt is stable, i think we shd start from fluid restriction..

Guys any inputs r welcome
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#7
h.
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#8
AGREE!! H is correct!
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#9
H ;makes sense to start with fluid restriction in Mild SIADH; In moderate SIADH NS; &in severe Hypertonic sol.
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#10
yup it shud b H
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