Approach to hyponatremia (pediatrics) Quiz: Ace Your Exams
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A 6-year-old boy was admitted to the intensive care unit for brain contusions and edema after being involved in a motor vehicle accident. Mental status has been within normal limits and stable; however, on day 2 of hospitalization, the patient has a new headache and feels weak. He vomited three times in the past hour and seems confused. He does not recognize his parents. Temperature is 37°C (98.6°F), pulse is 100/min, respirations are 18/min, blood pressure is 115/60 mmHg, and oxygen saturation is 96% on room air. Urine output is 3 mL/kg/hr. On physical examination, the patient is not oriented to person, place, or time. Mucous membranes are moist, and capillary refill is 2 seconds. Cardiopulmonary and abdominal exams are normal. Strength is 2/5 in all extremities. The patient suddenly develops generalized tonic-clonic seizures. Seizures are controlled with medications, and laboratory work is sent with the results shown below. Which of the following is the most appropriate next step in management?
| Laboratory value | Result |
| Hemoglobin | 12.5 g/dL |
| Leukocyte count | 7300/mm3 |
| Platelets | 275,000/mm3 |
| Sodium | 94 mEq/L |
| Potassium | 3.2 mEq/L |
| Chloride | 101 mEq/L |
| Bicarbonate | 22 mEq/L |
| Blood urea nitrogen | 15 mg/dL |
| Creatinine | 0.5 mg/dL |
| Glucose | 99 mg/dL |
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