A client who has been diagnosed with mild hyponatremia and has experienced gastric fluid loss from vomiting is about to receive Half Normal Saline (0.45% NaCl).
This intravenous fluid contains Sodium 77 mEq/L and Chloride 77 mEq/L.
It is contraindicated in cases of hypovolemia, hyponatremia, increased intracranial pressure, liver disease, trauma, and burns.
What should the client say to demonstrate understanding of the treatment plan?

Choice A rationale:

Thirst and dry mouth are early signs of dehydration.

When the body loses fluids, it signals the brain to increase thirst and conserve water.

Dry mouth can occur due to reduced saliva production when the body is dehydrated.

Choice B rationale:

Decreased urine output and dark-colored urine are indicators of concentrated urine, suggesting dehydration.

Reduced fluid intake or excessive fluid loss can lead to decreased urine production, and the urine becomes more concentrated, appearing darker than usual.

Choice C rationale:

Rapid heart rate and low blood pressure are signs of hypovolemic shock, a severe form of dehydration where the body cannot circulate enough blood to meet its needs.

This can happen in severe cases of dehydration when there is a significant loss of fluids and electrolytes.

Choice D rationale:

Poor skin turgor is a classic clinical sign of dehydration.

Skin turgor refers to the skin's ability to return to its normal position after being pinched.

In dehydrated individuals, the skin loses elasticity and remains tented or "pinched" after being pulled up.

This indicates a lack of fluid in the body.

Choice E rationale:

Increased energy and playfulness are not typical signs of dehydration.

Dehydrated children are more likely to be lethargic and irritable due to the physiological stress on their bodies.

The correct answer is Choice B: Total maintenance fluids = 1200 mL/day.

Choice A rationale:

This value exceeds the calculated requirement for a child weighing 18 kg using the Holliday-Segar method.

Choice B rationale:

The Holliday-Segar method calculates maintenance fluids based on weight as follows:

• For the first 10 kg, the requirement is 100 mL/kg.
• For the next 10 kg, the requirement is 50 mL/kg.

Thus, for a child weighing 18 kg:

• First 10 kg: 10 kg x 100 mL/kg = 1000 mL
• Next 8 kg: 8 kg x 50 mL/kg = 400 mL Total maintenance fluid requirement = 1000 mL + 400 mL = 1400 mL/day.

So, actually, the correct answer should be Choice D: 1400 mL/day.

Choice C rationale:

This value is higher than the requirement for 18 kg based on the Holliday-Segar method.

Choice D rationale:

This is the correct calculation based on the method described above: 1000 mL for the first 10 kg plus 400 mL for the next 8 kg totals 1400 mL/day.