Sigh...Is there anyone who can add 2+2 here?

[Arctickat]

So, here's the scenario....

Client is brought to local hospital with Hypoglycemia, 2 amps of D50, 50 grams total bring his sugars up, but he had taken his insulin the night before a cultural fasting (religion). For the next 12 hours our hospital tries to manage the hypoglycemia with a couple of amps of D50, 6 litres of D10W and 3 litres of D5W.

Then they do some lab work and freak out because the client also has hyponatremia.

They then decide to send the client to a larger centre because they cannot manage the care for the client here.

My first question to them was

"What were the Na levels prior to all the dextrose you gave him?"

"We don't know, we didn't check it."

"Hmm, d'ya think it might have something to do with his hyponatremia now?"

Sigh. The concept of D5S hasn't filtered down this far yet.

[MariB]

4! The answer is 4! The rest of what you said makes no sense to me yanno, emt level however I know how to take a blood sugar and I see dex50 pushed all the time

[paramedicmike]

4! The answer is 4!

No. The answer is three... or is it five? With this damned sixth finger I'm always counting wrong.

[MariB]

No. The answer is three... or is it five? With this damned sixth finger I'm always counting wrong.

We are screwed if you start using your toes.

[scubanurse]

It could also have to do with all the fluids run into the patient diluting their blood... 9L of fluid even D5 or D10 is a lot of fluid for a person and the hyponatremia could be caused by that.

[ERDoc]

The issue here is not the dextrose at all, it is the water that is being given. This pt has either euvoloemic or hypervolemic hyponatremia (I'd go with hypervolemic). Giving free water without electrolytes will lead to hyponatremia. Remember that woman that died in the "Hold your pee for a Wii," contest? This is pretty much the same thing.

[Kaisu]

I think the issue here is people who don't understand what they are doing. Its the same old argument - do what protocols say, or use protocols as a guideline and understand what you are doing.

I feel your pain Kat

[HellsBells]

So for this pt, would it be advisable to administer ringers lactate with the dextrose therapy?

[ERDoc]

In reference to the LR, are you talking about now, after the damage has been done or initially with the hypoglycemia?

[Chief1C]

OT

Which is better for dehydration; NS or LR?