Hi everyone!
I'm in ECC (emergency and critical care) class right now. The criticalists are utterly fantastic. I love the entire department. They are snarkily hilarious and teach us highly practical shit. Hooray!
Currently, we're talking about hypernatremia (too much sodium in the blood). If an animal becomes hypernatremic slowly, her body will adapt to its new overly salty state. More specifically, she will produce idiogenic osmoles. These hold water in the brain while all the extra sodium tries to pull the water into the blood.
So we're discussing what to do with a patient that presents with a sodium of (holy shit) 185 or so. You definitely want to start some IV fluids to rehydrate her and bring that sodium down, but if your fluids have a way lower sodium than your patient, the sodium will drop really fast.
If the patient has adjusted to her hypernatremic state and has made idiogenic osmoles, this is bad. Why, you ask? Because as the sodium in the blood drops rapidly, those idiogenic osmoles in the brain will pull water into the brain and cause it to swell like a gummy bear in a cup of Coke. Since the cranial vault has a fixed volume and since bone is not particularly bendy, your patient's brain will get squished. Bad, right? Yes.
So, what do you do?
We (as a class) said: "We're going to make our own fluids! With a sodium concentration similar to that of the patient!"
Our professor responded: "We ARE going to make our own! We're going to roll our own fluid. Absolutely."