NaCl 23.4% for hyponatremia?

Updated:   Published

hyponatremia-naci-treatment.jpg.16fb33d7297940902595d5460f1c7460.jpg

Had a patient that that had a sodium level of 129, the patient was fluid overloaded and a dialysis patient. The nephrologist ordered NaCl 23.4% in D10 continuous fluid at 50ml/hr also bumex pushes. This has been running for 4 days and the lab orders are only once daily. This has also been running in a 22g peripheral I.V. I’m not use to this treatment for hyponatremia, is this usual in some facilities?

1
Up Vote Up Vote ×

I would think you would need 2q sodiums and a central line.  That’s how 3% is done.  I can’t imagine 23%.  
 

For a sodium of 129 I’ve only ever used NS.  You don’t want to raise the sodium too quickly.  But my background is neuro with a tiny renal thrown in.  

3
Up Vote Up Vote ×
Specializes in Critical Care, Capacity/Bed Management.

That is highly unusual, we only use 23.4% sodium for neuro patients who are at risk for herniation at my facility and it is reserved for critical care. 

I would reach out to pharmacy and administration regarding the safety of infusing that on a floor. 

3
Up Vote Up Vote ×

In my experience, that kind of infusion is seen in neuro patients. As an above poster mentioned, a central line and very frequent labs are included.

Wouldn't some sodium chloride tablets be enough?

2
Up Vote Up Vote ×
10 hours ago, RNperdiem said:

In my experience, that kind of infusion is seen in neuro patients. As an above poster mentioned, a central line and very frequent labs are included.

Wouldn't some sodium chloride tablets be enough?

You would think or even NaCl 0.9% continuous, or even a NaCl 3% push. I work in a small hospital where many nurses have not ever left the town or hospital and don’t seem to question any order. Nobody can give me and answer, not even the provider at night. I don’t see the nephrologist as he only comes in during the day. I came from trauma 1 in a major city, I have worked in almost all ICUs and I have also only seen this in neuro. I think my coworkers are tired of me constantly asking questions (I’ve asked other questions in this forum regarding things I don’t understand). 

1
Up Vote Up Vote ×
Specializes in oncology.
20 minutes ago, Aloe_sky said:

I don’t see the nephrologist as he only comes in during the day.

Have you thought of calling him at home to ask or leave a message when he comes during the day? You all may find this odd but when I worked evenings (3-11) a long time ago I actually called the MD to find out why we were doing something. there was no animosity..rather praise for wanting to know why we were doing something.  Is there a resident you can ask? ASK, ASK, ASK!

2
Up Vote Up Vote ×

This seems odd, especially as I've never seen D10 23.4% NaCl.  I have seen 23.4% NaCl added to a bag of D10W to make eirher D10 0.45% NaCl or D10 0.9% NaCl. 

Is it possible that this is what's happening here?

1
Up Vote Up Vote ×
7 hours ago, londonflo said:

Have you thought of calling him at home to ask or leave a message when he comes during the day? You all may find this odd but when I worked evenings (3-11) a long time ago I actually called the MD to find out why we were doing something. there was no animosity..rather praise for wanting to know why we were doing something.  Is there a resident you can ask? ASK, ASK, ASK!

The P.A on nights didn’t know why it was ordered, I haven’t had that patient back and just questioned the nurse that has the patient tonight. The fluids are no longer running and she’s only on the unit twice a month, She has no idea about it. One day if I come across this again, I will call. 

1
Up Vote Up Vote ×
5 hours ago, chare said:

This seems odd, especially as I've never seen D10 23.4% NaCl.  I have seen 23.4% NaCl added to a bag of D10W to make eirher D10 0.45% NaCl or D10 0.9% NaCl. 

Is it possible that this is what's happening here?

I’m not sure, it said in the order NaCl 23.4% in D10 and that’s what it said on the bag. If it was to make D10 0.9%, would make sense!

1
Up Vote Up Vote ×
Specializes in Nephrology, Cardiology, ER, ICU.

Agree very weird. For a dialysis pt why not just adjust the dialysate bath? Also, you need to look at fluid restriction. If I was following this order, I sure as heck would order every 4 hour renal function panels or at the very least every 4 hour Na levels

 

3
Up Vote Up Vote ×
+ Join the Discussion