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 Replacement of Fluid Loss -- The initial goal is to correct intravascular volume. This process begins with isotonic saline (NS). The next order of business is to correct total body water deficit within 24 to 48 hours with hypotonic saline (1/2NS or D5-1/2NS). If initial corrected serum sodium is > 150 or when calculated serum Osm >320, switch to hypotonic saline. Begin initial replacement with NS at 1-2 L/hr for first 1-2 hours, followed by 250/hr. It is important to not administer fluid replacement in an aggressive manner since it can lead to symptomatic brain swelling and pulmonary edema.
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