questioning IV fluids

[SN2014]

The person was originally dehydrated (hypovolemic) and hypernatremic.

The first day the MD wanted D5 1/2 NS running at 84

.The 2nd day she switched the fluids to 1/2 NS @ 64

3rd day 1/2NS @20

4th day decided to bolus him with a 1L bag of 1/2 NS @999.

Some of those orders I questioned.. I know that I am not a doctor.. but I am just trying to understand the rationale.

Wouldn't a common fluid management of hypovolemic hypernatremia be a 1 L bolus of NS or LR ( an isotonic fluid), then gradual replacement w/ .45 NS to correct the hypernatremia ? (Without rapid shift of electrolytes) ?

Isn't D51/2NS hypertonic? Is that appropriate?

Have you ever heard of/gave a 1L .45 NS bolus @999ml/hr?

In what situations would that be applicable? Wouldn't that cause a rapid shift in electrolytes? Isn't that risky? (Increased risk of cerebral edema, seizures, etc.)

I don't have much experience but have never heard of 1/2 NS being ran at 999.. neither did my supervisor or co-workers.

Trying to understand the rationales/thought processes.

Input?

[offlabel]

I would have just asked the Doctor . But with more information , labs, vital signs, weight , LOC, other medications would help to know.

Best answer. Probably better to just ask in good faith with the intention of learning than to question the rationale with no basis for doing so.

[SN2014]

I would have just asked the Doctor . But with more information , labs, vital signs, weight , LOC, other medications would help to know.

I would have, too. However, it was done during the day... I picked up an hour after it was given, on night shift. There's no MD present at night, just an on-call physician (who isn't the one who ordered the bolus).