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Severe hypernatraemia — SCE Acute Medicine MCQ

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ModerateAcute Renal and Metabolic EmergenciesSevere hypernatraemiaSCE Acute Medicine

A 58-year-old man presents with vomiting, weakness, confusion or collapse. Relevant history includes diabetes, kidney disease, endocrine disease or a treatment trigger. On assessment, volume status and bedside physiology are abnormal. Investigations show sodium 166 with dehydration and high serum osmolality. What is the most appropriate next step in management?

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Correct answer: B — Restore intravascular volume then correct free-water deficit slowly

The key discriminator is that sodium 166 with dehydration and high serum osmolality, which makes Restore intravascular volume then correct free-water deficit slowly the single best answer. Optimise chronic medication and discharge is less appropriate because it does not address the dominant acute risk in the vignette; Give intravenous fluids with reassessment would fit a different presentation or later stage of care. Start anticoagulation after assessing bleeding risk and Arrange urgent CT imaging are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: NICE CG174