Why 1/2 normal saline?

Nurses General Nursing

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I'm trying to figure out why 1/2 normal saline would be ordered in my patient? Patient is here for uti and aki. BUN is in the 50-60 range, creatinine 2.5-3. Initial sodium was 131 and is now 136. Saw a note from the doc about continuing diuresis and holding lasix until the creatinine drops. I don't even see lasix or any diuretic in the MAR, but let's just say it is I can't figure the reason for using 1/2 NS instead of NS.

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Specializes in ER/Tele, Med-Surg, Faculty, Urgent Care.

Aki? This is a new one!

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Aki? This is a new one!

Acute kidney injury it's the abbreviation they use here.

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Specializes in ER/Tele, Med-Surg, Faculty, Urgent Care.

Is pt on dialysis ?

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Is pt on dialysis ?

Nope.

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Specializes in Pediatrics, Emergency, Trauma.

Think about the labs and the solution concentration; also with the acute kidney injury the BUN and Creat is going to be elevated for a while.

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Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.

Shoot.... I'm thinking this through, also as a student.

1/2 NS placed in vessels will pull water into the vessels.

If your pt has kidney issues, this may help to provide perfusion to the kidneys, which I think will in turn hopefully prevent kidney failure.

Without perfusion, kidneys will die and then the whole body will have adverse effects.

Am I on the right track, experiences nurses?

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Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.
I'm trying to figure out why 1/2 normal saline would be ordered in my patient? Patient is here for uti and aki. BUN is in the 50-60 range, creatinine 2.5-3. Initial sodium was 131 and is now 136. Saw a note from the doc about continuing diuresis and holding lasix until the creatinine drops. I don't even see lasix or any diuretic in the MAR, but let's just say it is I can't figure the reason for using 1/2 NS instead of NS.

Bun is elevated. Meaning kidneys not filtering correctly. Too much nitrogen.

Creatinine is elevated. Also, protein is breaking down, which refers to some organ being damaged, likely kidneys.

Sodium is slightly elevated. Hemoconcentration/low fluid volume comes to mind. Because kidneys can't filter and are excreting water. Not sure this is correct though.

I'm Thinking you continue diuretics simply because kidneys aren't functioning correctly and diueretics help produce Urine.

Lasix is held because it spills too much K or NA.

I'm confused. Experienced nurses, please give it to me straight.

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Think about the labs and the solution concentration; also with the acute kidney injury the BUN and Creat is going to be elevated for a while.

I'm thinking.. I read up to date at work on acute kidney injury. I could find nothing on 1/2 normal saline. I got that kidneys are not working thus elevated BUN and creatinine, but sodium is low to normal and that's what's throwing me off. My preceptor is not a good resource. She's been a nurse a few months longer than me and by her answer I don't think she knows why either.

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Okay more reading that's what I do when there's nothing to do at work. I think maybe I found something on Merck manuals that makes sense. "When postoliguric diuresis occurs, replacement of urine output with 0.45% saline at about 75% of urine output prevents volume depletion and the tendency for excessive free water loss while allowing the body to eliminate excessive volume if this is the cause of the polyuria." Is this the line of thought I should be going with?

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My thinking is that the doctor wants to replace/correct volume without increasing the serum sodium or chloride. My understanding is that this will expand the extracellular fluid and provide some free water to the cells. I think this makes sense in terms of the doctor wanting to continue to diurese the patient but wanting to hold Lasix until the creatinine drops (i.e. holding the Lasix until the patient's kidney function improves, as giving Lasix before the patient's kidney function improves could cause more damage to the patient's kidneys).

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Well to be honest, I cant really explain why 1/2 NS would be ordered for the patient for a simple UTI and AKI. The kidney injury is evidently due to the BUN and creatinine. With you stating that patient was once on lasix gives me the hint of a possible PMH of CHF which could also be the reason why she has an AKI and UTI (not enough perfusion to the kidneys). If that is the case she would be at a high risk of fluid overload and cerebral edema (chances are higher if old). See if the doctor can change it to a NSS instead?....but this is just my opinion and assumption anyways. lol. I'm only a student nurse.

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