There are many rotations, even in a "straight" EM program, that seem impractical for a future EM practice. One way to look at these is to assume that perhaps, someday, some specific aspect of that experience may prove useful. Even if that seems unlikely, it's always a good idea to know what goes on in the world of our consultants. Speaking their language, and understanding their limitations is very important in our practice where we may call on them to help our patients.
As for hyponatremia, I'm sure your IM colleagues will appreciate it greatly if you started the patient on the correct infusion rate. They gain respect for EM as a specialty and you as a practitioner, and it's better for the patient.
The huge majority of the time, the initial management is 500-1000 ml NS over an hour. If someone is altered (on the point of getting intubated because they are so gorked), or seizing, you can't go wrong with 1-2 cc/kg of 3% NS over the first hour, and let the admitting doctor decide what to do once they get follow-up labs. In 8 years of medical experience, I've only seen 3% normal saline given once. I can honestly say, that I've never had a patient where it was critical to figure out all of this data in the ED.
As an ER doctor, probably the worst thing you could do is correct the sodium too fast. In my opinion, not only are we not the best people to manage the hyponatremia over the next 8 hours, it is also not in the patient's best interest to have us dedicating 15 minutes of our day, looking up formulas, and calculating down to the last cc, exactly how much sodium they should get for the next 8 hours, 24 hours, etc. When in doubt, in a stable hyponatremic patient, we should err on the side of doing less. Lets face it, whatever number we come up with, the admitting doctor will disagree and change the order.
Admitting doctors will never give us respect because most of them are jerks, and they aren't grateful to their own mothers for bringing them into this world, let alone for the ER doctor to correctly calculating the correct sodium replacement in a hyponatremic patient.
Every minute that I spend calculating sodium replacement is a minute taken away from the other patients waiting in the ED, with chest pain, abdominal pain, weakness, and headaches, and lacerations waiting to get repaired. The last thing on my mind is "impressing IM doctors" with my ability to do their job. I'd rather focus on clearing out the waiting room, and getting my charting done.
