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SIADH — ABIM Board MCQ

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HardEndocrinology/MetabolismSIADHABIM Board

A 58-year-old taking a thiazide has a generalized seizure. Sodium is 112 mEq/L and glucose is normal. The seizure stops after initial airway support and a benzodiazepine. What is the next sodium-directed treatment?

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Correct answer: B — Give 3% hypertonic saline bolus with close sodium monitoring

The best answer is “Give 3% hypertonic saline bolus with close sodium monitoring”. A seizure is a severe neurologic manifestation of hyponatremia and requires immediate hypertonic-saline bolus treatment, regardless of the eventual cause. Sodium is rechecked after each intervention and subsequent correction is limited to avoid osmotic demyelination. Fluid restriction or oral salt is too slow, while uncontrolled isotonic correction can overshoot and diuretic monotherapy does not treat cerebral edema safely.

Reference: Society for Endocrinology Emergency Guidance for Severe Symptomatic Hyponatremia: https://pmc.ncbi.nlm.nih.gov/articles/PMC5314809/