Sodium of 196

[DrQuinn]

yup. 196. holy crap! She was a 98 year old lady that looked like a prune. Literally. Weird.

Q

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[edinOH]

salty

 

[southerndoc]

Wow, that has to be the highest sodium I've heard of.

Did you set a gallon of water in an open bucket next to her? I would imagine water would fly into her.

 

[DrQuinn]

Wow, that has to be the highest sodium I've heard of.

Did you set a gallon of water in an open bucket next to her? I would imagine water would fly into her.

yeah, such a weird case. 98, relatively healthy, three weeks ago, family said she was "real weak" and last week, basicaly just lied there, didn't talk, and just kept her mouth open and breathed. Since it didn't change in the past WEEK, they decided to call the ambulance. It took the lab FIVE hours to confirm the Na... I probably will end up writing it up, if indeed her Na+ was that high, I"ll wait for the urine studies and what the ICU guys find.... I am not kidding, she looked like a human raisin.

Q

 

[danielmd06]

Nice.

 

[peksi]

yup. 196. holy crap! She was a 98 year old lady that looked like a prune. Literally. Weird.

Q

Quinn,
I hope you double gloved when examining her to avoid the obvious osmotic effect on you from skin-skin contact!

 

[southerndoc]

yeah, such a weird case. 98, relatively healthy, three weeks ago, family said she was "real weak" and last week, basicaly just lied there, didn't talk, and just kept her mouth open and breathed. Since it didn't change in the past WEEK, they decided to call the ambulance. It took the lab FIVE hours to confirm the Na... I probably will end up writing it up, if indeed her Na+ was that high, I"ll wait for the urine studies and what the ICU guys find.... I am not kidding, she looked like a human raisin.

Q

Although CPM usually occurs with hyponatremia, it can also occur with rapid correction of hypernatremia. Just a hunch, but I suspect your patient might be at a slight risk!

 

[Hernandez]

holy crap, what was the serum osm that went along with that? 450?

 

[Painter1]

yeah, such a weird case. 98, relatively healthy, three weeks ago, family said she was "real weak" and last week, basicaly just lied there, didn't talk, and just kept her mouth open and breathed. Since it didn't change in the past WEEK, they decided to call the ambulance. It took the lab FIVE hours to confirm the Na... I probably will end up writing it up, if indeed her Na+ was that high, I"ll wait for the urine studies and what the ICU guys find.... I am not kidding, she looked like a human raisin.

Q

how did u guys manage her in the ED before she was whisked away to the ICU?

 

[roja]

wow

 

[group_theory]

Did she have an anion gap?

 

[Sessamoid]

Sodium of 196? Is her husband's name "Lot"?

 

[BellKicker]

Although CPM usually occurs with hyponatremia, it can also occur with rapid correction of hypernatremia. Just a hunch, but I suspect your patient might be at a slight risk!

Southerndoc, is that right? Give me the power to pimp, man. What's the mechanism?

In my simplistic view, CPM "dries out" the cells by osmosis. In hypernatremia, you usually worry about brain edema because of the opposite effect.

 

[BellKicker]

yup. 196. holy crap! She was a 98 year old lady that looked like a prune. Literally. Weird.

Q

And Wow, that's crazy. Did she make it?

 

[hyperbaric]

Sodium of 196? Is her husband's name "Lot"?

i don't get it...

<-- short bus rider

 

[toxic-megacolon]

Although CPM usually occurs with hyponatremia, it can also occur with rapid correction of hypernatremia. Just a hunch, but I suspect your patient might be at a slight risk!

I think you have your hypo and hyper backwards. Correcting this person's sodium too rapidly would result in cerebral edema. I'm assuming you'd use NS and not a hypotonic solution?

 

[Dimoak]

I think you have your hypo and hyper backwards. Correcting this person's sodium too rapidly would result in cerebral edema. I'm assuming you'd use NS and not a hypotonic solution?

I don't know, from Dr. Q's description is does sound like the pt is severely hypernatremic, but an overly zealous attempt to correct it with non-saline fluids would likely give her some sort of edema prior to making her hyponatremic.

 

[DrQuinn]

actually i just checked teh computer two days ago, she coded. She was DNR/DNI when she came in, and was freakin 98 years old, so I don't know if family withdraw care or anything..... so I don't know the circumastances of how she died, but once I get a hold of the chart and everything I plan to write this one up........

Q

 

[SanDiegoSOD]

i don't get it...

<-- short bus rider

Biblical reference. Lot's wife was turned to a "pillar of salt"; so if this ladies husband was Lot... well you get the picture.