Question

Mr. H has tuberculosis, serum sodium is 121 mEq, he is also stuporous. The doctor's order indicates that the patient should receive 3% saline IV. The doctor orders that the saline solution should be run at 150 mL/hr. Would you question this order?

A.) No, 3% saline is an isotonic solution.
B.) No, you are going to give it through a filtered line
C.) Yes, because 3% saline needs to be given slowly.
D.) Yes, 3% saline is more likely to cause edema

Answer 1

3% saline is hypertonic, not isotonic. It should be administered slowly to avoid complications, making option C the correct response for Mr. H's situation. A saline solution that causes destruction of red blood cells was likely hypertonic.

Step-by-step explanation:

A 3% saline solution is considered hypertonic, not isotonic. If a patient dies and autopsy reveals many red blood cells have been destroyed after being injected with a solution that was believed to be isotonic, it indicates that the solution was likely hypertonic. Hypertonic solutions can cause red blood cells to shrink and potentially burst (hemolysis) due to the osmotic pressure gradient, which suggests that the solution the doctor injected was not really isotonic. Considering the scenario with Mr. H, who has a serum sodium level of 121 mEq and is stuporous, the doctor's order of a 3% saline IV at 150 mL/hr should be questioned, specifically for the reason denoted by option C: Yes, because 3% saline needs to be given slowly. A rapid infusion of hypertonic saline can lead to significant complications, including central pontine myelinolysis. It is crucial to administer hypertonic solutions at a controlled rate to avoid rapid shifts in fluid and electrolyte balance that can harm the patient.