All are used for mangement for hypernatremia except
Ans. is `c' i.e., Nil by mouth T/T of Hypernatremia :? As hypernatremia develops, water moves out from I.C.F. to E.C.F. to maintain equal osmolality inside and outside the cell. So the intracellular fluid decreases. To compensate for this the brain cells generates idiogenic osmoles to increase the intracellular osmolality and prevent the loss of brain water. This mechanism is not instantaneous and is most prominent when hypernatremia has developed gradually. If the hypernatremia is corrected rapidly by administration of fluids, the E.C.F. osmolality lowers rapidly, and now the I. C.F becomes hyperosmotic in comparison to the E.C.F. So, now there is movement of water from serum into the brain cells to equalize the osmolality in the two compament. This results in brain swelling and most commonly it manifests as seizures in infants. (This is clinically similar to hyponatremia) Because of the dangers of ovely rapid correction, hypernatremia should not be corrected rapidly. The goal is to decrease the serum sodium by less than 12-10 mEq/L even, 24 hr, at a rate of 0.5-10 mEq/h. In patients with chronic hypernatremia (hypernatremia that has been present for longer than 48 hours). The treatment regimen is 5 percent dextrose in water, intravenously At a rate of (1.35 mL/hour x patient's weight in kg), or About 70 mL per hour in a 50 kg patient and 100 mL per hour in a 70 kg patient. The goal of this regimen is to lower the serum sodium by a maximum of 10 meq/L in a 24-hour period (0.4 meq/ L/hour). In patients with known acute hypernatremia (hypernatremia that has been present for 48 hours or less). The treatment regimen is (see 'Initial fluid repletion regimen' above) :- 5 percent dextrose in water, intravenously, at a rate of 3 to 6 mL/kg per hour The serum sodium and blood glucose should be monitored every one to two hours until the serum sodium is lowered below 145 meq/L. Once the serum sodium concentration has reached 145 meq/L, the rate of infusion is reduced to 1 mL/kg/hour and continued until normonatremia (140 meq/L) is restored. The goal of this regimen is to lower the serum sodium by 1 to 2 meq/L per hour and to restore normonatremia in less than 24 hours. Patients with diabetes insipidus will also require desmopressin therapy, which is discussed elsewhere. Hyperglycemia may develop with rapid infusions of 5 percent dextrose; to avoid increased water losses from glycosuria, a slower rate of infusion or a change to 2.5 percent dextrose in water may be required after several hours. Risk of correctionof hypernatremia. The treatment goal for chronic hypernatremia is designed to lower the serum sodium by 10 meq/L in 24 hours (12 meq/L in 24 hours is considered the maximum safe limit, 10 meq/L in 24 hours is chosen to increase to safety
5% dextrose in water
N/2 in 5% dextrose
Nil by mouth
Indomethacin