CASE: 52 yo male in Haiti drank 3 beers the night before, awoke and drank 3 liters of water. During the AM, he continued to drink another 4-5 liters of water, had a late lunch. By Dinner time, he feels nauseated, gets `2L ringers lactate. He is checked on but shows worsening with facial and peripheral edema. VS: 150/80 HR 80, RR 16, SaO2=86%. He is treated presumptively with a drug that completely reverses his condition within a few hours.
Diagnosis???
SEVERE HYPONATREMIA.
NA=117!!!
This was our friend, Rick's, condition last night. We gave him 40mg lasix (no 3% saline here....), with IVF, Na corrected to 121 after 6L of urine output in the next several hours. With diligent care by Kyonna, our ICU nurse, who replaced his urine output cc for cc, titrated his IVF drips per my orders, emptied his catheter (yes, he got a foley catheter), by morning, his sodium is corrected. He is raring to go back to work , but we are encouraging him to take it easy. Thanks everyone for your prayers and giving us the ability to treat him in the most sublime of conditions.
Thank you for the update on Rick who is my brother. Despite correcting the hyponatremia, the systemic effects of this electrolyte disturbance and the heat will not be good for his functioning as a medical professional. He should come back home to recuperate and should be encouraged to do so by his medical colleagues.
ReplyDeleteJames N. Skupski MD, MPH
HI Dr.Walsh can you please give this message to our Mommy "Kyonna",
ReplyDeleteThank you for acknowledging my lovely mother "Kyonna"!She really puts her heart into whatever she does.Including being a mother of 2! we love her with all out hearts and would love it if she comes home in one whole piece! (LoL) We love you mommy!
Haha! I just had to laugh..there's the poor guy (who I don't know) under the mosquito netting with the crummy Na...and then there's Dr. Walsh like: 'Isn't this GREAT?!' Oh that man is a hoot!
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