A 63-year-old woman with small cell lung cancer has a generalised seizure. Sodium is 112 mmol/L, serum osmolality is low, urine osmolality is 620

Question

A 63-year-old woman with small cell lung cancer has a generalised seizure. Sodium is 112 mmol/L, serum osmolality is low, urine osmolality is 620 mOsm/kg and urine sodium is 74 mmol/L. She is euvolemic on examination. What is the most appropriate management?

Accepted Answer

Give 3% hypertonic saline boluses with close sodium monitoring

Answer

Dextrose infusion to lower urine osmolality

Answer

Fluid restriction alone for the first 24 hours

Answer

Loop diuretic monotherapy without sodium monitoring

Answer

Rapid correction to normal sodium within 6 hours

Severe symptomatic hyponatremia due to SIADH — RCPSC IM MCQ

A 63-year-old woman with small cell lung cancer has a generalised seizure. Sodium is 112 mmol/L, serum osmolality is low, urine osmolality is 620 mOsm/kg and urine sodium is 74 mmol/L. She is euvolemic on examination. What is the most appropriate management?