case_images: PMC8371619_01
case_images: Overall fluid balance for the first week of PICU hospitalization as demonstrated by bar graphs of daily intake and output totals. The composition of fluids is depicted in color. Daily net fluid balance is depicted by triangles. Note the large net positive fluid balance on day 2 of hospitalization (3/25) with achievement of near net balance after initiation of Furosemide on day 3 (3/26).
case_images: CRICC2021-5942431.001.jpg
case_images: PMC8371619_01_CRICC2021-5942431.001.jpg
case_images: fig1
case_images: These panels quickly revealed a steady worsening of hypernatremia to a maximum value of 171 mmol/L associated with increasingly abundant UOP of more than 4 L on the first day of hospitalization (Figures 1 and 2). After five doses of IV Furosemide over a 48-hour period along with reduction in the Vasopressin dose, successful diuresis along with resolution of hypernatremia was achieved (net balanced fluid balance of -497 mL and reduction in serum sodium to 138 mmol/L, respectively) (Figures 1 and 2).
case_images: Serum sodium levels throughout first few days of admission. Blue arrows represent dates of hospital stay. Note the peak value of 171 mmol/L on day 2 of admission (3/25) with eventual decline after initiation of Furosemide with Vasopressin. Concurrent Vasopressin dosing is evidenced by yellow arrows. Note the initiation at 0.5 mU/kg/hr on 3/24, with a maximum infusion rate of 8 mU/kg/hr on 3/25, and eventual decline in dosing starting 3/26.
case_images: CRICC2021-5942431.002.jpg
case_images: PMC8371619_01_CRICC2021-5942431.002.jpg
case_images: fig2
case_images: These panels quickly revealed a steady worsening of hypernatremia to a maximum value of 171 mmol/L associated with increasingly abundant UOP of more than 4 L on the first day of hospitalization (Figures 1 and 2). After five doses of IV Furosemide over a 48-hour period along with reduction in the Vasopressin dose, successful diuresis along with resolution of hypernatremia was achieved (net balanced fluid balance of -497 mL and reduction in serum sodium to 138 mmol/L, respectively) (Figures 1 and 2).