diluted Na in Blood

[acenab4jc]

Had a patient recently, HIE, coolcap, DIC, third spacing, anuric times a few days, then less than 1 ml/kg/hr. Her serum Na was 117 - 121, Cl 78 - 82, K 3.6 - 4. I was told by the Fellow and NNP (per attending involved in case) that we weren't to aggressively correct these labs because the patient's blood was diluted and we wouldn't know her "real" sodium level until she started to diurese. Is this a correct way of thinking? I, and nurses more senior than me, had never heard of this. So if this is true, would her "normal appearing" K really be much higher? I was just wondering. Thanks.

[acenab4jc]

nevermind, reading other stuff on internet - we just never heard it here

[umcRN, BSN, RN]

cooling kids also tend to have crazy electrolyte imbalances, and you don't want to over correct a sodium level too fast, in my unit the docs will usually write for new fluids but expect the sodium to correct over the next 6-8 hours, not instantly like you might want a K bolus to correct a low K

[littleneoRN]

Hemodilution....adequate sodium but too much fluid leads to a low serum sodium concentration. Just like adequate sodium in the presence of dehydration leads to high serum sodium concentration.

[SteveNNP, MSN, NP]

Plus, you don't want to add sodium (which can cause fluid retention) into an already 3rd spacing baby.

Did you guys do urine electrolytes, to see if she was losing vast amounts of sodium in her albeit small volume of urine? It's a long shot, but it's an easy way to check.

Sounds like oliguric-phase ATN. Just wait, she'll be peeing so much, you won't be able to pump enough sodium and K into her fast enough.