Na goes from 117 to 135 in less than 4 hours.... Possible?

  1. Hi All!

    So to make this story as short as possible, I recently admitted a pt. who came in for hyponatremia (Na apparently at 117 at 1500), so we ran IVFs (just NS) and such until the doc made his rounds. After such, he ordered supplemental IVFs and kept the NS @ 125 going to see if that would help any. Lab was ordered to make draws q4 hours, and at 2000, the sodium was 116 :-/, so the MD orders 3% hypertonic NS. Because of severe dehydration, it was almost impossible to get an IV in, so after multiple tries, we finally get access and and start the hypertonic at about 2300...

    So shortly after we start, the lab notifies the MD that the 2245 sodium draw is now miraculously at 135! Keep in mind that the hypertonic was started right after lab got that draw.

    Is it possible for your sodium level to spike that quick in such a short time only with NS going at 125cc/hr? Or does that sound like a lab fluke?

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    About tmartin83, BSN

    Joined: Apr '11; Posts: 106; Likes: 34
    RN; from US
    Specialty: 5 year(s) of experience in Medical/Surgical, Ambulatory Care


  3. by   PunkBenRN
    Um, I don't know how quick it needs to be replaced to cause this, but I would be concerned of central pontine myelinolysis - all I know is that this can happen if you replace sodium too quick.

    After re-reading your post, it sounds like a false high from dehydration - what was the BUN and Cr like?
  4. by   tmartin83
    Thanks! That makes more sense. BUN and Cr were WNL. I think her K was 3.1, and her Ca was like, 7.8. But now that you mention it, i think the false high would be more plausible, because I dont see how just NS could do that in a matter of 4 hours.... and it's funny because right before that miracle lab draw, the pt was feeling much better.

    Central pontine mylenolysis (I just looked this up and learned something new :-)) could be a possibility after thinking about it, but the pt was feeling like poo way before hand... (just a head CT and CXR), but again, I'm not so sure :-/...

    I was also kinda thinking diabetes insipidus, because of polyuria and the sodium wasting. I put a foley in at about 1950, and at 2300, the output was at 1700 :-/... But no other s/s were present.... Sooo confusing! I really wish I knew but it still baffles me.
  5. by   PunkBenRN
    That is really confusing, ha. Normally if people are dry, you can see their BUN elevate and they have a normal Cr. Central Pontine Mylenolysis wouldn't happen with just normal saline, only if they tried to replace the sodium and then if it went in too quick or for too long.

    Glad to hear the Pt felt better! Have you asked the Doc or other co-workers about it too?