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SIADH — RACP Paediatrics MCQ

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HardNephrologySIADHRACP Paediatrics

A postoperative 6-year-old receiving hypotonic fluid develops a generalised seizure. Sodium is 116 mmol/L, glucose is normal and examination suggests euvolaemia. What must take priority?

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Correct answer: E — Give hypertonic sodium immediately with serial neurological and biochemical correction monitoring

Explanation lettering: D = shown as A · E = shown as C · C = shown as D · A = shown as E

A is correct because a hyponatraemic seizure is a medical emergency and may resist anticonvulsants until sodium is raised with hypertonic therapy. B is too slow. C misapplies chronic overcorrection risk to immediate cerebral oedema. D is not the targeted emergency therapy in euvolaemic SIADH. E overshoots the limited initial rise needed for neurological improvement and increases osmotic injury risk. Serial sodium, fluid balance and treatment of the precipitant follow immediately.

Reference: Royal Children’s Hospital Melbourne, Hyponatraemia: https://www.rch.org.au/clinicalguide/guideline_index/hyponatraemia/