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basic rule to correct hypovolumia is give isotonic fluid to stabalize BP and then give what pt has lost--goljan
now,,marathon runner at the end of his race collapses his bp 90/70,HR 102,tilt test +,,his serum na is 165.
what do i do,giving him isotonic fluid will make him more Na OVERLOAD but acc to goljan this is correct ans.
qs.2, Diabetes insipidus pt has serum sodium 165,now goljan says treat this pt with D5W and dont give him 1/2 normal saline or else he will be salt overloaded.
kap surgery says;treat gradually develpoed hypernatremia by volume repletion with D5 1/2 NSand not with D5Wand rapidly develpoed hypernatremia with cns sx is treated by diluted fluidseg D5W.
m getting more confused can anyone plz summarize this in easy.
thanks .

I think u already summarized the thing very well.....acute hypernatrimia...u need to give give D5W..aim is to reduce the Na by 1meq/hr to a max of 10-12 in a day to avoid CPM

for the one which has gradually developed give DNS solution with the same rate of correction

acute hypernatremia +hypovolumia bp90/60,,iv normal saline or D5W,
im sorry sir i opened kap medicine and first sentence it has mentioned in treatment of acute hypernatremia is treated by isotonic fluids iv which contradicts kap surgery which says in acute hyperna use D5W.
this is cofusing me.

well...thats what I would do as I explained....the first scenario...is a acute dehydration with loss of hypotonic fluid with hypotension is a different scenario.....he would need isotonic saline for resucitation...bcoz D5% is not going to increase his bp...but in general treatment of hypernatrimia is as summarised by u is valid

thanku sir.