In a patient with severe hyponatremia and acute kidney injury in the setting of hypovolemic shock, would fluid resuscitation take precedence over the rate at which sodium is corrected?
In a patient with severe hyponatremia and acute kidney injury in the setting of hypovolemic shock, which approach do you prioritize?
Join Mednetto vote and see how they answered.
Normal saline, or a balanced fluid, e.g., Lactated Ringers or Plasmalye, if you are believers in balanced fluids.
Shock trumps ANY concerns over rate of Na rise.
Also if someone is in shock they are not going to have a water diuresis from volume.
Agree with aggressive fluid resuscitation, but could DDAVP blunt the rate of sodium increase as urine output is re-established.
I believe it is possible to achieve both aims. Even though normal saline is more efficient in increasing extracellular volume, administration of D5W will lead to some increase in the extracellular volume not to mention half normal saline. Through careful combination of the fluid administered and frequent serum sodium concentration checks it is possible to increase the extracellular fluid volume and keep the serum sodium from rising too rapidly.