Fluid maintenance and deficit replacement — viva

Opening (must-hit)

"This child has hospital-acquired hyponatraemia, almost certainly from hypotonic maintenance fluid in the postoperative state. The 0.45 percent saline is hypotonic, and after surgery her ADH is raised by the stress response, so her kidney is retaining free water and her sodium has fallen to 131. Her drowsiness is the early signal of hyponatraemic encephalopathy. My immediate plan is to stop the hypotonic fluid, change to an isotonic maintenance fluid — 0.9 percent saline with 5 percent dextrose and potassium chloride — reassess her neurological state, and check the sodium again. I would escalate to a higher-acuity bed because she is symptomatic." ^[2][7]