A post operative patient is receiving dextrose 5% and 0.45 normal saline at 160 ml/hour. The nurse notices puffiness, weight gain of 2 kg and hypotension with complaints of muscle cramps and confusion. The serum sodium level is 126 mEq/L. Which of the following is the most likely cause of these findings?
Fluid overload and hyponatremia
The patient is receiving a hypotonic infusion (5% dextrose with 0.45% saline) at a high rate of 160 ml/hour.
Puffiness and a 2 kg weight gain indicate retention of excess fluid — fluid overload.
Serum sodium of 126 mEq/L (normal 135–145) is hyponatremia; excess free water dilutes sodium. Low sodium causes muscle cramps and confusion (cerebral oedema).
The hypotension reflects the effect of severe hyponatremia, with fluid shifting out of the vessels into the tissues; the weight gain and puffiness still point to fluid overload.
Dehydration is ruled out by the weight gain and oedema, and nothing suggests excess dietary sodium or potassium deficiency.
Hence, Fluid overload and hyponatremia.
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Important Questions from Medical-Surgical Nursing
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