Fluids and electrolytes

Fluid status should be monitored closely. Since dilutional hyponatremia is always present water restriction should be instituted first.

If hypoglycemia appears, 10 per cent hypertonic glucose-containing solutions should be administered. If the glucose osmotic diuresis is insufficient to correct hyponatremia, intravenous loop diuretics at progressive doses may be used to decrease the negative free-water clearance ( Nicolo.ffMl§D.d.MllLoPr§stj 1993). If severe hyponatremia and seizures are present, hypertonic saline infusion must be considered: hypertonic sodium chloride (514 mmol/l) should be delivered by a constant infusion pump at a rate set to increase the sodium concentration by about 1 mmol/l/h until neurological signs have disappeared.

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