Dying for a drink

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Question 1 of 3

1. Question
As part of her initial assessment in the emergency department a venous gas is taken:
- pH 7.43
- CO2 4.05
- HCO3 21.2
- Na 110
- K 3.6
- Gluc 11.4
What is the most probable cause of seizure?
- Intracranial space occupying lesion
- Antacid overdose
- Hyponatraemia
- Primary seizure
- Cessation of olanzapine
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Question 2 of 3

2. Question
You suspect her hyponatraemia is due to Psychogenic Polydipsia.

What treatment will you give in the first hour?
- 1L NaCI 0.9% over 1 hour
- 150ml NaCI 2.7% over 20 minutes. Give a further 150mls until sodium has risen by 5mmol/L
- Nothing – need to get Plasma Osmolality, Urine sodium and Urine Osmolality back to guide treatment first.
- Give Furosemide 40mg IV – she needs diuresis
- Give Sodium Valproate 30mg/kg over 15mins to prevent further seizure
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Question 3 of 3

3. Question
A colleague raises concern that replacing the sodium too fast may lead to osmotic demyelination syndrome. They state you should only increase sodium by 8 mEq/L per day and are concerned you are giving too much. You disagree on this occasion because… (select all that apply)
- The patient has severe symptoms and requires rapid sodium administration to reduce her symptoms, regardless of whether this is an acute hyponatraemia or chronic hyponatraemia problem
- The patient is not at high risk of suffering from Osmotic demyelination syndrome as she isn’t malnourished, alcoholic or hypokalaemic and her sodium level is above 105 mEq/L
- You suspect her hyponatraemia is acute because of Psychogenic polydipsia and as such she is unlikely to have developed the brain adaptations that are associated with demyelination upon sodium replacement.
- Emergency management of hyponatraemia with severe symptoms targets a rise of 5mmol/L in the first hour.
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Dying for a drink

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