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Acute Severe Hyponatraemia — ESENeph MCQ

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ModerateElectrolyte DisordersAcute Severe HyponatraemiaESENeph

A 60-year-old man has serum sodium of 110 mmol/L and is having seizures. He is euvolaemic. What is the immediate emergency treatment?

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Correct answer: C — IV hypertonic saline (3%) – 150 mL bolus over 20 minutes; can repeat twice

Severe symptomatic hyponatraemia with seizures is a medical emergency. European Hyponatraemia Guidelines (2014) recommend immediate 150 mL bolus of 3% hypertonic saline over 20 minutes, with repeat boluses (up to 3 times) if symptoms persist. This aims to raise sodium by 4-6 mmol/L acutely to stop seizures. Total correction should not exceed 10 mmol/L in 24 hours. Tolvaptan should not be used for acute severe symptomatic hyponatraemia. Desmopressin may be used as a 'rescue' if overcorrection occurs.

Reference: Spasovski et al 2014 – ERA-EDTA/ESE/ESA Hyponatraemia Guideline