surgery
qusei - الثلاثاء, 2007-08-07 18:08 | الجراحة | المحتوى الطبي
الوصف الكامل Background
Five days after an uneventful
cholecystectomy, an asymptomatic
middle-aged woman is found to
have a serum sodium level of 120
meq/L. Proper management would
be
a. Administration of hypertonic saline
solution
b. Restriction of free water
c. Plasma ultrafiltration
d. Hemodialysis
e. Aggressive diuresis with furosemide
cholecystectomy, an asymptomatic
middle-aged woman is found to
have a serum sodium level of 120
meq/L. Proper management would
be
a. Administration of hypertonic saline
solution
b. Restriction of free water
c. Plasma ultrafiltration
d. Hemodialysis
e. Aggressive diuresis with furosemide
occurs following elective surgical procedures. It is usually
the result of the combination of appropriate postoperative stimulation
of antidiuretic hormone and injudicious administration of excess free
water in the first few postoperative days. Totally sodium-free intravenous
fluids (e.g., dextrose and water) should be given with great caution postoperatively,
since occasionally the resulting hyponatremia can be associated
with sudden death from a flaccid heart or with severe permanent
brain damage. The condition is usually best treated by withholding free
water and allowing the patient to reequilibrate spontaneously. At levels
below 115 meq/L, seizures or mental obtundation may mandate treatment
with hypertonic sodium solutions. This must be done with extreme care
because the risk of fluid overload with acute pulmonary or cerebral edema
is high.
16
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