Case: Hospital Course
The patient was admitted to the intensive care unit due to acute neurological symptoms. In light of this medical emergency, a 100 ml bolus of 3% saline was administered. She became alert and regained orientation to person, place and time. Approximately four hours after hypertonic therapy, the sodium levels increased to 115 mmol/L. Additionally, a free water restriction of 1 liter per day was instituted and no further treatments with hypertonic saline were needed. Twenty-four hours after hypertonic therapy, the sodium level rose to 119 mmol/L. At this time, patient was initiated on oral urea-sodium at 45grams per day. Sodium levels improved gradually over the course of the patient’s hospitalization with a discharge value of 129 mmol/L. On admission, potassium chloride was started for hypokalemia and repletion was based on the concurrent increase in the sodium levels.