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Hyponatraemic seizure — SCE Acute Medicine MCQ

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HardAcute Renal and Metabolic EmergenciesHyponatraemic seizureSCE Acute Medicine

A 54-year-old woman has a generalised seizure caused by acute symptomatic hyponatraemia; sodium is 112 mmol/L and serum osmolality is low. The seizure has stopped after benzodiazepine treatment. What sodium-directed treatment is most appropriate now?

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Correct answer: A — Give 150 mL of 3% saline and reassess

A seizure is a severe symptom of hyponatraemia and requires a bolus of hypertonic saline, aiming for an initial rise of about 5 mmol/L rather than normalisation. Sodium should be checked after each bolus and total correction limited to avoid osmotic demyelination. Cause-specific treatment follows once immediate cerebral oedema has been addressed.

Reference: https://www.endocrinology.org/media/xhrhxhxm/emergency-management-of-severe-and-moderately-severely-symptomatic-hyponatraemia-in-adult-patients-2022.pdf