Dietary recommendations for a patient with a hypotonic fluid excess should include:
A. Decreased sodium intake
B. Increased sodium intake
C. Increased fluid intake
D. Intake of potassium-rich foods
Correct Answer: B. Increased sodium intake
Hypotonic fluid volume excess (FVE) involves an increase in water volume without an increase in sodium concentration. Increased sodium intake is part of the management of this condition. Hypotonic dehydration occurs when sodium loss is greater than water loss, resulting in a decrease in serum osmolality. This causes a shift of water from the extracellular space into the intracellular space. The cells swell and cerebral edema may occur.
Option A: Hyponatremia can be acute or chronic. If sodium loss occurs for more than 48 hours, it becomes chronic hyponatremia, and the body may adapt to this state. Sodium imbalance mainly manifests as neurological symptoms ranging from headaches, nausea, lethargy, and potentially confusion, coma, and death.
Option C: Adequate hydration is recommended during all activities to prevent dehydration. Water intake is key to replacing fluid lost during exercise, in hot weather, during hospitalization, and in elderly patients with impaired thirst sensation.
Option D: Intravenous fluids can be used for fluid replacement in unconscious patients with severe dehydration while plain water, sports drinks with electrolytes, and oral rehydration solutions are used for the prevention and treatment of mild dehydration. Electrolyte monitoring is mandatory for patients using diuretics for prolonged periods.
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