A 48-year-old woman on ICU following major abdominal surgery develops a sodium level of 118 mmol/L. She is drowsy (GCS 13) and has had one generalised...

Question

A 48-year-old woman on ICU following major abdominal surgery develops a sodium level of 118 mmol/L. She is drowsy (GCS 13) and has had one generalised seizure. Her sodium was 136 mmol/L on admission 24 hours ago. Urine osmolality is 580 mOsm/kg, serum osmolality 248 mOsm/kg, and urine sodium 85 mmol/L. What is the most appropriate immediate management?

Accepted Answer

IV hypertonic saline (3%) - 150 mL bolus over 20 minutes

Answer

Fluid restriction to 1 L/day

Answer

Oral demeclocycline

Answer

IV normal saline (0.9%) at 125 mL/hr

Answer

IV tolvaptan

uk-fficm MCQ (SBA): Severe Hyponatraemia