A patient with HHS has received initial fluid. Glucose is falling, but measured sodium has risen from 148 to 152 mmol/L while effective osmolality is

Question

A patient with HHS has received initial fluid. Glucose is falling, but measured sodium has risen from 148 to 152 mmol/L while effective osmolality is steadily decreasing and neurologic status is improving. What is the best interpretation?

Accepted Answer

Continue osmolality-guided treatment; the sodium rise can accompany glucose correction

Answer

Give a large insulin bolus to normalize sodium immediately

Answer

Stop all fluid because any sodium rise proves treatment is too rapid

Answer

Diagnose central diabetes insipidus in the absence of further assessment

Answer

Start hypertonic saline to match the measured sodium

Hyperosmolar hyperglycemic state — RCPSC IM MCQ

A patient with HHS has received initial fluid. Glucose is falling, but measured sodium has risen from 148 to 152 mmol/L while effective osmolality is steadily decreasing and neurologic status is improving. What is the best interpretation?