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Symptomatic hyponatraemia — RACP Paediatrics MCQ

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HardNephrologySymptomatic hyponatraemiaRACP Paediatrics

A 5-year-old presents with status epilepticus. After seizure control, serum sodium is found to be 118 mmol/L. The child has ongoing reduced consciousness. What is the most appropriate immediate fluid management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — 3% hypertonic saline

Symptomatic severe hyponatraemia (seizures, encephalopathy) requires urgent correction with 3% hypertonic saline (2-3 mL/kg over 10-15 minutes, repeated if needed). The aim is to raise sodium by 4-6 mmol/L acutely to control symptoms, then correct slowly (max 8-10 mmol/L per 24 hours) to avoid osmotic demyelination.

Reference: RCH Melbourne – 2023 – Hyponatraemia CPG; RACP Paediatric Curriculum – Nephrology