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High-burden polypharmacy in multimorbidity — SCE Geriatric Medicine MCQ

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HardMultimorbidityHigh-burden polypharmacy in multimorbiditySCE Geriatric Medicine

An 82-year-old malnourished woman with chronic thiazide-associated hyponatraemia presents with sodium 108 mmol/L. Twelve hours after the thiazide is stopped and saline is given, sodium is 120 mmol/L; urine output rises to 350 mL/hour and urine osmolality falls to 90 mOsm/kg. She is haemodynamically stable. What should happen next?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Stop therapy; give glucose and desmopressin, then monitor sodium closely

Explanation lettering: B = shown as A · A = shown as B · D = shown as C · C = shown as D

A would accelerate an already dangerous 12 mmol/L rise. B increases aquaresis and overcorrection risk. C adds hypertonic sodium when re-lowering is required. D creates an unpredictable electrolyte and volume balance. E is correct: stop active correction and obtain expert help to re-lower sodium with electrolyte-free water and 2 micrograms IV desmopressin under close sodium, urine-output and fluid-balance monitoring. The brisk dilute diuresis signals restored free-water excretion and high osmotic-demyelination risk.

Reference: European clinical practice guideline on hyponatraemia: https://academic.oup.com/ejendo/article/170/3/G1/6668028