A patient, diagnosed with a traumatic brain injury, is demonstrating signs of cerebral salt wasting. Which of the following should be included in this patient's plan of care?
1. treat with salt tablets, intravenous normal saline, and expect correction in a few weeks
2. restrict fluids
3. provide potassium chloride intravenous replacements
4. treat with sodium restriction and intravenous dextrose 5% and water
1
Rationale: Patients with cerebral salt wasting will present with low serum sodium and a low serum and urine osmolality. Cerebral salt wasting is a state of hypovolemia so the patient should be treated with salt replacement via intravenous saline and oral salt tablets. The patient should not be on a sodium restriction nor provided with intravenous dextrose 5% and water. Cerebral salt wasting tends to correct itself over the course of 3 to 4 weeks. The patient's fluids should not be restricted since this will exacerbate the hypovolemia. Potassium replacements are not indicated in the treatment of this complication. A high urine output could indicate a worsening condition and should not be expected.
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