A 9-year-old girl is on day three of treatment for pneumococcal meningitis and has been receiving intravenous…

Question

A 9-year-old girl is on day three of treatment for pneumococcal meningitis and has been receiving intravenous sodium chloride 0.9% with glucose 5% at full maintenance. She is more drowsy today. Her weight has risen 0.9 kg since admission, there is no oedema, her blood pressure is 104/62 mmHg and capillary refill is under two seconds. Serum sodium is 124 mmol/L (135-145), serum osmolality 258 mmol/kg, urine sodium 82 mmol/L and urine osmolality 610 mmol/kg. Which one of the following changes to h…

Accepted Answer

Restrict fluid to half of maintenance

Answer

Change to sodium chloride 0.45% with glucose 5%

Answer

Give sodium chloride 0.9% 20 mL/kg as a bolus

Answer

Increase the rate to maintenance plus a 5% deficit

Answer

Start an infusion of sodium chloride 3%

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