this post was submitted on 25 Oct 2024
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Insight from someone whos clients are too familiar with hospitals and have specific needs and low incidence conditions is that the process is so standardized and uninclined to change. Ambulances and other hospital staff refusing to listen to a patients mom instead of following their protocall gave one person with disabilities a dangerous level of hyponatremia.
They're on a medication that makes them hold water so we've been instructed to tell people he needs whats called half normal saline for his IVs or he'll be overhydrated and his blood salt levels plummet. Its a 50/50 if the responder listens to us or just does their normal protocal. In emergency situations his parents no longer call rescue or take him to the hospital until they have one of his doctors on the phone, because then people listen instead of almost kill him.
Half-normal saline would make hyponatremia substantially worse. Half-normal saline has half as much salt and is much closer to plain water. If he has water retention problems and issues with hyponatremia, he should be getting hypertonic saline which is 3% NaCl. For reference, normal saline is 0.9% NaCl, half-normal saline is 0.45% NaCl. Not enough NaCl is what can lead to "overhydration".
Edit: Also, most ambulances carry normal saline and not much else. They might have Lactated Ringers solution, but they don't have all the different concentrations of saline on the rig. There's just not enough space when the vast majority of patients just need isotonic (normal saline) fluids.