QqqqqQ(Self made question32) - sweety_usmle

[ArchivalUser]

A 20 years male is brought to your emergency department with complains of fever, nausea and vomiting with lower quadrant abdominal pain. There is no signifiant medical or surgical history and the patent doesn't take any long term medication of any illness. He says he doesn't do smoking, alcohol or illicit drug use. Vitals are P: 80bpm, BP:110/80mm of Hg, T: 38.6C, RR:14. You decide to do CT scan of the abdomen which comes back with the diagnosis of Acute Appendicitis. The patent was rushed to the OR and appendectomy was performed and he was given 5DW with half NS. On the next day, the first post op day the patient seems to be confused and when you were taking rounds he had two tonic clonic seizure back to back. You ask to get the serum sample and it came as sodium being 118mEq/L. What is the most appropriate therapy?

A. 0.9% NS
B. 3% NS
C. 5DW
D 5DW with half NS
6. Lorazepam
7. Phenytoin

[ArchivalUser]

A 20 years male is brought to your emergency department with complains of fever, nausea and vomiting with lower quadrant abdominal pain. There is no signifiant medical or surgical history and the patent doesn't take any long term medication of any illness. He says he doesn't do smoking, alcohol or illicit drug use. Vitals are P: 80bpm, BP:110/80mm of Hg, T: 38.6C, RR:14. You decide to do CT scan of the abdomen which comes back with the diagnosis of Acute Appendicitis.He was rushed to OR and appendectomy performed. On the next post op day you ask to get the serum sample and it came as sodium being 130mEq/L. What is the most appropriate therapy?

A. 0.9% NS
B. 3% NS
C. 5DW
D 5DW with half NS

[ArchivalUser]

1. A
2. C

[ArchivalUser]

1. B*** (hypertonic Saline)
2. C ( but since its 130 w/o symptoms) dont you just withdraw the fluids,

[ArchivalUser]

could you give further explanations on when hypertonic saline vs normal saline vs 5dw are used?

since both of these patients seem euvolemic I would go with

1. A

2. C

[ArchivalUser]

oh in euvolemic i thought you treat underlying and give normal saline for the first question. so confused

[ArchivalUser]

But doesnt the patient in Q 1 has neurological complications (confusion + tonic clonic seizures) I think this demands correction and his sodium levels are pretty low 118

so 1. B?

for the second one I am not too sure,
patient has no symptoms so wont you just withdraw fluids and let him equilibrate

[ArchivalUser]

1-B...Sodium 118mEq/L severe and confused and two tonic clonic seizure back to back

2-...sodium 130mEq/L. mild hyponatriemia and asymptomatic...if in your choices was fluid restriction ,I preferred to chose that rather than A

usually less than 125 is symptomatic

[ArchivalUser]

thanks