LAUSR

corded at 165 mmol/L. This scenario presented a very complex clinical conundrum, where large volume crystalloid resuscitation was indicated, but resuscitation fluids would be hypotonic to this patient’s serum invoking substantial risk of obstructive hydrocephalus and central pontine myelinolysis as potentially fatal side effects.2 Certainly, sacrificing the central nervous system in favor of overall perfusion would be as fruitless as not supporting perfusion to avoid detrimental central nervous system side effects.3 The authors having been faced with this scenario before and have arrived at a management schema which we have used successfully in the past and again on this occasion. Both issues were addressed by administering 250 mL/h of 0.9% saline concurrently with 50 mL/h of 3% saline. Coupled with usual health care–associated antibiotic therapy, the patient was off triple pressors and had a serum sodium level of 155 mmol/L after 36 hours of resuscitation. Obtundation gave way to response to voice and a neurological examination ultimately matching that of his preseptic state (Table 1). There is currently no literature on the choice of fluids in a patient with cerebral edema while septic. This essentially was 1.25% saline running at 300 cc/h. This composition allowed adequate resuscitation at a rapid rate but at the same time preventing a large drop in sodium risking fatal neurological complications. This topic needs to be studied further, but we believe that this is a start to an important area of Neurological Critical Care medicine.