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Severe hyponatremia — RCPSC IM MCQ

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HardNephrologySevere hyponatremiaRCPSC IM

A 72-year-old woman on hydrochlorothiazide is brought in after a generalized seizure. Sodium is 112 mmol/L, serum osmolality is low, urine osmolality is 480 mOsm/kg, and glucose is normal. She is somnolent but protecting her airway. What is the most appropriate management?

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Correct answer: C — Give 3 percent hypertonic saline boluses with close sodium monitoring

Seizure due to severe symptomatic hypotonic hyponatremia requires urgent hypertonic saline to raise sodium enough to stop cerebral edema while avoiding overcorrection through close monitoring.

Reference: Hyponatremia emergency guidance; Canadian nephrology practice