Approach to hypernatremia (pediatrics) Quiz: Ace Your Exams
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A 7-month-old girl presents to the emergency department with severe diarrhea, vomiting, and decreased urine output for 2 days. The patient refuses to feed from the bottle or breast. There is no swelling, or shortness of breath. Temperature is 37.5°C (99.5°F), pulse is 201/min, respirations are 30/min, blood pressure is 69/36 mmHg, and oxygen saturation is 97% on room air. On physical examination, the patient is irritable with a high-pitched cry and sunken eyes. Mucous membranes are dry and capillary refill is 4 seconds. Cardiopulmonary and abdominal exams are normal. There is generalized hypertonia in all extremities with brisk reflexes. Lab results are shown below. Which of the following is the most appropriate next step in management?
| Laboratory value | Result |
| Sodium | 151 mEq/L |
| Potassium | 4.5 mEq/L |
| Chloride | 104 mEq/L |
| PH | 7.21 |
| PCO2 | 40 mmHg |
| Bicarbonate | 16 mEq/L |
| BUN | 25 mg/dL |
| Creatinine | 0.9 mg/dL |
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