3% Saline

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    So, here I am sitting in the ICU of a hospital ship off the coast of Liberia.

    We have a little boy here who came in with a rapidly-growing Burkett's Lymphoma tumor in his jaw/airway. While in surgery he arrested. Got quality CPR and is now trached and vented with 2 chest tubes and a central line. (Probably the only ones in the whole country at the moment.) CT on days showed cerebral edema.

    When I came in for nights, his sodium was 127. The doc started 3% saline at 10/hr (kiddo weighs 13kg) and has been running all night. We're sending another set of lytes now (it's 6am).

    NOW, to the question ... we don't have an ICU doc here at the moment. The hospital doc is just a general internist I believe. I don't have the boy tonight, so I wasn't trying to be prying into it all too much, but it seems like 3% is a little agressive for a sodium of 127. And also, are we not risking bringing it up too fast and causing worse edema?

    What are your protocols for bringing up sodium levels with 3% saline? Any dos and dont's to share? Any tidbits at all would be appreciated. Hopefully his sodium will be fine-o and we can stop the 3%, but I'm still pretty dang curious.
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  3. 7 Comments so far...

  4. 0
    Hi, so I've been working in the PICU for about a year now, so while I'm not a wealth of experience, I have seen 3% saline used quite frequently for post-op neuro kids, controlling ICP, cerebral edema/hypertension, etc. I'm not exactly sure what led to the cerebral edema in this child's case but using 3% saline is used for it's osmotic effect. It's hypertonicity is going to pull that extra fluid off the brain, decreasing the edema and swelling (vital to his brain survival). A sodium of 127 is very low and 3% saline is not too agressive a treatment. It is commonly used as a continuous infusion ranging between 0.1 and 1 ml/kg of body weight per hour. You're right in that you don't want to bring up the sodium too quickly, so it's important to monitor as frequently as possible the sodium levels. In these cases we're usually checking levels every two hours. The low sodium could be caused by a few things. Due to stress of surgery and possible fluid overloading, sodium levels can drop and fluid is going to start leaking into tissues, thus leading to this kids cerebral edema. Not sure on the exact location of the tumor or their approach during surgery, but if it is anywhere near base of the brain sometimes the pituitary gland is affected...leading to changes in the regulating of antidiuretic hormone and sodium/fluid shifts. Anyway, not sure if that helps.

    So actually I wanted to ask you a question, if you don't mind? You're on the Mercy Ships, am I guessing correctly? I'm seriously considering coming to volunteer for several months at least later this year (I'm going to apply in these next couple weeks), and I've really been wanting to find out what it's been like from a nurse's perspective. I actually asked them if they could put me in touch with someone on the ship to talk to, but nobody has gotten back to me about it, so it's kind of funny to hear you mention this on here. Maybe you wouldn't mind sharing a little about your experiences on the ship and what you think about it? (this is my first time on here, not sure if have to start another thread, or can give out email on here?).

    I hope you enjoy the rest of your experience there.
  5. 0
    Quote from Nightingale1231
    You're on the Mercy Ships, am I guessing correctly?
    You got it! PM me and I'll give you my email address and blog and I can point you to the blogs of a few other nurses on here at the moment. I would be way more than happy to answer any questions you might have. I just might take me a bit to get back to you- I'm in the middle of my 5th out of 7 nights in a row, so I may be a zombie for a few days coming up =)
  6. 0
    This is completely off topic, and I'm not a nurse yet so I can't help at all... but, I follow a blog of a family who's baby you guys just opperated on March 9th. They are still raising the money to adopt him, but he had a terrible cleft lip/palate and they were so thrilled that Mercy Ships took him on and they were able to get him treatment now, instead of waiting until they can afford to bring him to the states later this year.
    I plan to adopt from Liberia soon after I complete my nursing degree, so it's a location that has a special place in my heart. Thank you so much for the sacrifices you're making and the people you are caring for who would die or suffer greatly without the work you do!:heartbeat
  7. 0
    Quote from april&em
    This is completely off topic, and I'm not a nurse yet so I can't help at all... but, I follow a blog of a family who's baby you guys just opperated on March 9th. They are still raising the money to adopt him, but he had a terrible cleft lip/palate and they were so thrilled that Mercy Ships took him on and they were able to get him treatment now, instead of waiting until they can afford to bring him to the states later this year.
    I plan to adopt from Liberia soon after I complete my nursing degree, so it's a location that has a special place in my heart. Thank you so much for the sacrifices you're making and the people you are caring for who would die or suffer greatly without the work you do!:heartbeat
    PLEASE PLEASE PLEASE send me a link to their blog. PM me it. I love that little boy. I wasn't able to care for him while he was here because I was on another ward, but I just saw him last week when he came in for a post-op appointment. He looked amazing, sucking down his bottle like a champ! I would love to get in touch with them. =)
  8. 0
    Unless there is a rule on allnurses.come preventing you from posting the links to those blogs I think more than just 2 of us would love to know them...

    Thank you!

    Mark

    P.S.
    Sorry for the thread hijack.
  9. 0
    Quote from mcbismark
    Unless there is a rule on allnurses.come preventing you from posting the links to those blogs I think more than just 2 of us would love to know them...

    Thank you!

    Mark

    P.S.
    Sorry for the thread hijack.
    there is actually- you can't post links to outside blogs. =( which makes sense. so PM away! and also, let me know and I can send you folks links to mine and some other blogs of people here on the ship. makes for some pretty good reading. I mean, I'm here and I still read their blogs! =)

    and no worries about hijacking the thread ... the situation in the OP has long since come to a conclusion.
  10. 0
    I know this is from a while ago, but I was wondering if someone could message me the links to those blogs? I can't PM yet (havent posted 15 times!). I am very intersted in mercy ships and would love some info!
    Thanks!


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