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Vaccine before biologic therapy — ABIM Board MCQ

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HardRheumatology/Allergy/ImmunologyVaccine before biologic therapyABIM Board

A 48-year-old woman taking hydrochlorothiazide presents with a generalized seizure. Sodium is 108 mEq/L, potassium 2.7 mEq/L, and chronicity is uncertain. She has alcohol-use disorder and low body mass. What is the best initial sodium-management strategy?

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Correct answer: A — Bolus hypertonic saline targeting a 4–6-mEq/L initial increase

The best answer is “Bolus hypertonic saline targeting a 4–6-mEq/L initial increase”. A seizure is a severe symptom requiring prompt small-volume hypertonic saline bolus therapy; the initial goal is symptom control with a modest 4–6 mEq/L rise, not normalization. Her alcoholism, malnutrition, hypokalemia, and uncertain duration confer high osmotic-demyelination risk, so frequent monitoring and proactive or reactive desmopressin may be needed to cap correction.

Reference: Hyponatremia Demystified: Integrating Physiology to Shape Clinical Practice: https://pmc.ncbi.nlm.nih.gov/articles/PMC9993811/