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Hyponatremic seizure — ABEM Board MCQ

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ModerateRenal/Metabolic emergenciesHyponatremic seizureABEM Board

A 73-year-old woman taking thiazide diuretics has a generalized seizure in triage. Triage acuity is ESI 1; BP 146/84 mm Hg, HR 96/min. Sodium is 112 mEq/L, glucose is normal, and CT head shows no hemorrhage. She is postictal. Which of the following is the most appropriate initial action?

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

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Correct answer: B — Give 3% hypertonic saline bolus

Severe symptomatic hyponatremia with seizure requires hypertonic saline boluses to raise sodium enough to stop cerebral edema.

Reference: European/US hyponatremia guidance