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Prediabetes lifestyle — USMLE Step 3 MCQ

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HardAmbulatory Medicine / Primary CarePrediabetes lifestyleUSMLE Step 3

A 54-year-old woman taking hydrochlorothiazide has a generalized seizure. Sodium is 112 mEq/L, glucose is normal, and examination shows no edema. What treatment should be given immediately?

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Correct answer: C — Give a 100-mL 3% saline bolus now and reassess symptoms

The best answer is “Give a 100-mL 3% saline bolus now and reassess symptoms”. Seizure is a severe neurologic manifestation. Hypertonic-saline boluses are used immediately to obtain an initial 4–6 mEq/L rise; subsequent correction is tightly limited to avoid osmotic demyelination. Severe symptomatic hyponatremia warrants hypertonic-saline boluses targeting an initial 4–6 mmol/L rise.

Reference: US/Irish Expert Panel: Hyponatremia Treatment: https://pmc.ncbi.nlm.nih.gov/articles/PMC10843202/