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Severe symptomatic hyponatremia — ABEM Board MCQ

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HardRenal/Metabolic emergenciesSevere symptomatic hyponatremiaABEM Board

A 54-year-old woman arrives as ESI 2 with confusion after taking hydrochlorothiazide and drinking large amounts of water. Sodium is 112 mEq/L and she has a generalized seizure in the ED. Which of the following is the most important immediate intervention?

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Correct answer: D — Administer 3% hypertonic saline bolus

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

Reference: European and US hyponatremia guidelines