Calculating the remaining allowance
He is on a fluid restriction of 1,000 mL per 24 hours that counts all oral and intravenous intake. All liquids count: 150 + 60 + 240 + 90 + (2 × 100) = 740 mL, so 1,000 − 740 = 260 mL remains. The answer is 260 mL.
What counts toward the restriction
In SIADH, the problem is excess free water, so every source of fluid matters. Coffee, water taken with tablets, soup, and ice chips all count, with ice chips recorded as their melted volume. IV medication diluents and flushes are also included when the order specifies all intake. Missing any single source makes the restriction less effective and can allow sodium to keep falling. The nurse keeps a running total throughout the day so that the remaining allowance is known at any time.
| Item | Volume |
|---|
| Coffee | 150 mL |
| Water with tablets | 60 mL |
| Soup | 240 mL |
| Ice chips (melted) | 90 mL |
| IV antibiotic, 2 doses | 200 mL |
| Total | 740 mL |
| Remaining | 260 mL |
Why the other answers are wrong
500 mL results from leaving out the soup. 460 mL results from leaving out the IV antibiotic volume. 350 mL results from leaving out the ice chips. Each distractor corresponds to a source that is commonly overlooked in practice, which is the lesson of the item.
Making the restriction tolerable
The remaining allowance is spread over the rest of the day rather than consumed at once. Thirst is eased with frequent oral care, mouth rinses that are not swallowed, and sugar-free gum or hard candy. The nurse explains the purpose of the restriction to the client and family so they do not bring extra drinks, and monitors sodium, neurologic status, and weight.
Exam takeaway
Watch out In fluid-restriction math, count every source, including ice chips as melted volume and IV medication diluent. Then subtract from the daily limit.