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Posted On : 10 Nov 2014

sir,this 1yr infant was brought to me in status epilepticus which was controlled . the child remained irritable and altered sensorium . which was attrubuted to hyponatremia {se-Na 115} . Lp ctsan and other blood parameters were normal. initially Na was correceted rapidly ,{3 percentNacl} and then with isotonic saline.after Dollar48hrs se.Na is 127 meq with normal urine output.Butthe child sensorium has worsened and has devleoped hypertension with bradycardia.should Mannitol or lasix should be added_? how do we correct se Na then_?His ABG is normal with normal aniongap. urinary Na is 70mmols, l se osmolality is260 and urinary osmo. is 140mmmol, l.

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Altered sensorium with bradycardia and hypertension is raised ICT. Mannitol with serum sodium of 127 is contraindicated. Try and increase the sodium to at least 140 meq, l. Get an MRI done to get to the primary pathology. For cause of hyponatremia rule out SIADH and Cerebral salt wasting.

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