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Water Intoxication - D5/W - Nurses To Blame, Court Says
Legal Eagle Eye Newsletter for the Nursing Profession
Quick Summary: The child was brain damaged from cerebral edema from too rapid infusion of IV fluid without sodium. The day nurses should have kept closer watch of the IV fluid infusion rate, especially with a pediatric patient and no pump being used, and recognized his drowsiness as a sign of water intoxication, the court said.
The Supreme Court of Nebraska had to decide whether to uphold the state medical board for suspending a physician’s license for gross negligence. The court decided the physician showed poor judgment in not checking more closely how the nurses were managing the patient, but that was not gross negligence. The nurses mismanaged this patient’s care, the court concluded.
A three year-old boy had an uneventful hernia surgery. He went to the recovery room at 9:30 a.m. with a 500 cc IV bag of five percent dextrose and water with no sodium, running at 40 cc per hour to keep the IV open until he awoke and was eating. The boy would most likely be ready for discharge from the hospital by mid-afternoon.
The IV was started just before 8:00 a.m. and no regulating pump was used. By 10:10 a.m. when he left the recovery room for the outpatient floor about 250 cc of fluid had infused since the IV was started.
By 11:45 a.m. the 500 cc bag was empty and a nurse hung a second 500 cc bag. According to the court, this meant another 250 cc infused in just one and one-half hours. Then a nurse hung a third 500 cc bag just before 6:00 p.m.
The nurse who came on duty for the 6:00 p.m. to 6:00 a.m. shift realized something was wrong. The boy was still drowsy. Then he seized. She called the physician. He related it to a history of febrile seizures, and ordered Ativan. Then he seized again, but his temperature was normal, so the nurse called to tell the physician this was not a febrile seizure.
Langvardt v. Horton, 581 N.W. 2d 60 (Neb., 1998).