Two days after admission to the hospital for treatment of a fractured femur and closed head injury sustained in a motor vehicle collision, an 8-year-old girl has a brief, generalized tonic-clonic seizure. CT scan of the head on admission disclosed no abnormalities. She has no history of serious illness. Oral acetaminophen was initiated for pain, and the patient underwent open reduction and internal fixation of the fracture. She receives no routine medications. Today, she appears drowsy but responds to questions appropriately. She is at the 55th percentile for height, weight, and BMI. Temperature is 36.8°C (98.2°F), pulse is 92/min, respirations are 24/min, and blood pressure is 106/64 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 95%. Pupils are equal and reactive to light and accommodation. Ocular movements are full. Muscle strength is 5/5, and deep tendon reflexes are normal. Results of serum studies are shown: Na+ 122 mEq/L K+ 3.8 mEq/L Cl− 94 mEq/L HCO3− 24 mEq/L Glucose 80 mg/dL Calcium 8.8 mg/dL
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