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A 67-year-old woman on hydrochlorothiazide is brought in with confusion and a witnessed seizure.
Na+ 118 mEq/L · Urine osm 420 mOsm/kg · Euvolemic on exam
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IM-0472 · NEPHROLOGY
✓ A — 3% hypertonic saline. Severe symptomatic hyponatremia (seizure, ΔMS) warrants a 100 mL 3% saline bolus — correct no faster than 8 mEq/L per 24 h to avoid osmotic demyelination.