Divine Intervention IM Shelf Practice Test

In cases of hypovolemic hypernatremia, the primary concern is to restore the patient's intravascular volume while also correcting the elevated sodium levels. The first step in treatment typically involves administering Normal Saline (0.9% NaCl). This isotonic solution helps to replenish the extracellular fluid volume effectively, addressing the hypovolemia and mitigating the risk of further complications.

Normal Saline is preferred because it delivers both sodium and fluids without raising the serum sodium levels further, which is crucial in managing hypernatremia. Once the volume status is stabilized and urinary output increases, further adjustment of sodium levels can be done, often through more specific solutions, depending on the patient's ongoing needs.

The other options would not be suitable as the initial treatment. For instance, administering D5W might exacerbate the situation because it could contribute to further dilution of the intravascular volume without effectively addressing the hypovolemia. Fluids with electrolytes could be too concentrated or inappropriate depending on the specific electrolyte abnormalities present. Oral fluids may not be sufficient or safe for patients who are significantly hypovolemic, especially if they are unable to safely intake fluids due to their clinical state.