ETOH is out of control

 It seems that COVID has hit ppl hard right now. So many of our patients are in due to ETOH abuse/detox issues. 

I wonder what happens in one's life for a person to give up sobriety and hit it so hard that you cause yourself to have a seizure from hyponatremia?!

Any of you know about hyponatremia and why it can be so dangerous? When you have someone's Na level so low that they have a seizure or fall into a coma, you really want to make sure that it increases slowly. If it increases too quickly, you can get demyelination, brain edema or brain herniation.

Unfortunately, my patient had other thoughts in mind. 

We were doing serial q4hr electrolyte checks to make sure we were aware of where the sodium levels stood. I checked the level and then my partner encouraged me to go on break. I advised her that she needed to make sure she was looking for this value and to ensure that the MD was made aware of the level.

I came back from break, our usual time frame and yet there was still no level back. We are in the midst of doing team nursing and so I had four patients to tend to - one needy patient, one trying to climb out of bed and pull lines, and then I had a legit sick patient.... plus all the usual hourly things that I was responsible for.

So of course the sodium level was overlooked, and lab didn't call me because said level normalized and they don't call anyone for "normal" values.... shitty in this case.

Long story short, the value rose much too quickly - like by 13 points in like 4 hours.... damn. And the MD comes down the hall saying "hey, why didn't you call me with this value like I told you I needed you to? They patient has been getting too much of this kind of fluid for at least 2 hours".... I advised him that I couldn't help it, when I got back from break the value wasn't returned and then I got busy with these other ICU patients.... thankfully he's an understanding MD and was like, ok, change the fluid.... which I did promptly.

Doing q1hrly neuro checks denoted no changes in said patient's neuro status thankfully. Even 24 hours later, no obvious damage was noted. It didn't seem to matter what fluid we put this patient on, because the sodium value still rose of its own accord.

I'm sure that in a couple of days the patient be back in their own abode, going back to the alcohol that put them in the ICU in the first place. Such a shame.