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Beer potomania with rapid sodium correction — ABIM Board MCQ

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HardNephrologyBeer potomania with rapid sodium correctionABIM Board

A malnourished man with alcohol use has chronic sodium 112 mEq/L, potassium 3.0 mEq/L and low urine osmolality. After saline, sodium reaches 121 mEq/L in six hours. Neurologic status is unchanged. Which intervention is indicated?

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Correct answer: D — Give desmopressin and electrolyte-free water to relower sodium

The best answer is “Give desmopressin and electrolyte-free water to relower sodium”. He is at high risk for osmotic demyelination and has already exceeded a conservative daily correction limit. Desmopressin stops water diuresis and dextrose water can relower sodium. Continuing saline, adding a vaptan or standard dialysis would worsen overcorrection; potassium replacement also contributes to tonicity and must be included in the plan.

Reference: US Expert Panel Recommendations on Hyponatremia: https://pubmed.ncbi.nlm.nih.gov/24074529/