Question

A 70-year-old woman presents with confusion, nausea and muscle weakness. Serum sodium is 115 mmol/L, serum osmolality is low, and urine osmolality is inappropriately high with urine sodium 50 mmol/L. There are no signs of hypovolaemia, and she takes a selective serotonin reuptake inhibitor. What is the most appropriate initial rate of sodium correction to minimise risk of osmotic demyelination?

Accepted Answer

Correct by no more than 8-10 mmol/L in the first 24 hours

Answer

Increase serum sodium by 1-2 mmol/L per hour until normal

Answer

Aim to normalise sodium (>=135 mmol/L) within 24 hours

Answer

Delay all treatment for 24 hours to avoid rapid correction

Answer

Use hypertonic saline to raise sodium 20 mmol/L in first day

Practice question