50 y/o female with history of alcohol abuse presents with diarrhea for the past several days. HR 120 BP 60/30. Exam notable for cachectic appearing female with dry mucus membranes and poor skin turgor. Patient is fatigued but has a non-focal neuro exam. Na 115 BUN 60 Cr 2.0. CBC normal. No baseline labs for comparison. What is your resuscitation fluid of choice?

While normal saline is generally the favored fluid for volume expansion, use of this fluid in patients with hypvolemic hyponatremia has lead to central pontine myelinolysis.  Consider use of 1/2 NS or alternating NS with 1/2 NS.  No matter what, closely monitor Na.


Source

Oh, M. et al.  "Case Report: Danger of Central Pontine Myelinolysis in Hypotonic Dehydration and Recommendation for Treatment"  American Journal of the Medical Sciences.  July 1989.