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Provoked Seizure – Hyponatraemia — SCE Neurology MCQ

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HardEpilepsy & Seizure DisordersProvoked Seizure – HyponatraemiaSCE Neurology

A 62-year-old taking a thiazide has a generalised seizure with serum sodium 108 mmol/L and normal glucose. Airway and seizure treatment are underway. Which initial hypertonic-saline protocol matches Society for Endocrinology emergency guidance?

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Correct answer: A — Give 150 mL of 3% saline over 20 minutes, recheck sodium and repeat to a 5 mmol/L rise

Because a seizure is a severe neurological manifestation of hyponatraemia, hypertonic saline is an immediate emergency treatment. The guidance specifies 150 mL of 3% saline over 20 minutes, followed by a sodium check and further boluses, up to two additional administrations, until symptoms improve or sodium has risen by about 5 mmol/L. The immediate aim is relief of cerebral oedema, not normalisation. Subsequent correction limits and frequent monitoring remain essential to reduce osmotic demyelination risk.

Reference: Society for Endocrinology Emergency Guidance: severe symptomatic hyponatraemia. https://pmc.ncbi.nlm.nih.gov/articles/PMC5314809/