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Myxoedema coma precipitated by pneumonia — SCE Acute Medicine MCQ

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HardAcute Renal and Metabolic EmergenciesMyxoedema coma precipitated by pneumoniaSCE Acute Medicine

A malnourished woman with chronic hyponatraemia is treated for a seizure. Sodium rises from 108 to 119 mmol/L in eight hours and urine output abruptly increases. The seizure has stopped. What is the most appropriate next step?

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

An 11 mmol/L rise in eight hours in a malnourished patient substantially exceeds a safe correction limit and creates high risk of osmotic demyelination. Stop active correction and use desmopressin with intravenous 5% glucose, under specialist monitoring, to halt aquaresis and relower sodium toward the permitted trajectory. Frequent sodium and urine-output checks are essential.

Reference: https://www.endocrinology.org/media/xhrhxhxm/emergency-management-of-severe-and-moderately-severely-symptomatic-hyponatraemia-in-adult-patients-2022.pdf