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.