A patient with hyponatremia begins seizing on the ward. You are called to see them two hours after a hypertonic prescription; their drip is still 0.9% normal saline. How should you respond?

A patient with hyponatremia begins seizing on the ward. You are called to see them two hours after a hypertonic prescription; their drip is still 0.9% normal saline. How should you respond?

• A. Stabilise the patient, cease normal saline, start hypertonic saline, escalate if seizures persist, and administer anti-epileptics as needed.
• B. Continue observation and adjust later if seizures continue.
• C. Openly disclose to the patient what happened without taking immediate action.
• D. Document the event and wait for later discussion.

Answer: (A)

In acute symptomatic hyponatremia with seizures, the priority is rapid stabilization and correction of the sodium deficit to stop ongoing cerebral edema and prevent further neurological injury. Immediate steps include stopping the ineffective isotonic saline and starting hypertonic saline to raise serum sodium promptly. At the same time, manage the seizures—benzodiazepines or similar anti-seizure therapy as needed—and ensure airway, breathing, and circulation are secure with continuous monitoring. If seizures persist despite initial hypertonic boluses, escalate care (often to ICU) and consider additional hypertonic treatment, while continuing seizure control. Throughout, monitor sodium levels closely to avoid overcorrection and osmotic demyelination, adjusting therapy as the patient stabilizes.

In acute symptomatic hyponatremia with seizures, the priority is rapid stabilization and correction of the sodium deficit to stop ongoing cerebral edema and prevent further neurological injury. Immediate steps include stopping the ineffective isotonic saline and starting hypertonic saline to raise serum sodium promptly. At the same time, manage the seizures—benzodiazepines or similar anti-seizure therapy as needed—and ensure airway, breathing, and circulation are secure with continuous monitoring. If seizures persist despite initial hypertonic boluses, escalate care (often to ICU) and consider additional hypertonic treatment, while continuing seizure control. Throughout, monitor sodium levels closely to avoid overcorrection and osmotic demyelination, adjusting therapy as the patient stabilizes.