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Severe hyponatraemia with seizure — SCE Acute Medicine MCQ

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ModerateAcute Renal and Metabolic EmergenciesSevere hyponatraemia with seizureSCE Acute Medicine

A 48-year-old woman is assessed on the acute medical unit. She has a generalised seizure and sodium is 112 mmol/L after starting a thiazide. Serum osmolality is low. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: A — Give hypertonic saline bolus with close sodium monitoring

Give hypertonic saline bolus with close sodium monitoring is the best answer because severe symptomatic hypotonic hyponatraemia requires controlled hypertonic saline to reduce cerebral oedema. Give vitamin K and prothrombin complex concentrate is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Over-rapid correction risks osmotic demyelination.

Reference: https://www.nice.org.uk/guidance#acute-medicine-order-99-1