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.