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.