Fluid & Electrolyte Q 18 - Gyan Darpan : Learning Portal
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Tuesday, 29 March 2022

Fluid & Electrolyte Q 18

Which of the following intravenous solutions would be appropriate for a patient with severe hyponatremia secondary to syndrome of inappropriate antidiuretic hormone (SIADH)?
    A. Hypotonic solution
    B. Hypertonic solution
    C. Isotonic solution
    D. Normotonic solution

Correct Answer: B. Hypertonic solution

When hyponatremia is severe, hypertonic solutions may be used but should be infused with caution due to the potential for the development of CHF. This water retention dilutes serum sodium levels, making the patient hyponatremic and necessitating the administration of hypertonic solutions to balance sodium and water.

Option A: In SIADH, isotonic and hypotonic solutions are not indicated, because urine output is minimal, so water is retained. Patients presenting with severe symptoms such as seizures, confusion, or delirium need urgent initial correction with hypertonic saline infusion for the first few hours rather than just water restriction.
Option C: A 100 mL bolus of 3% hypertonic saline is given in the first 3 to 4 hours, and sodium levels are measured within 2 to 3 hours so that further doses can be adjusted to avoid correcting too rapidly. A rise of 3 to 4 mEq/L within the first few hours in such distressing conditions can be justified.
Option D: Normotonic solutions do not exist. If the patient’s mental status does not improve, more boluses of 100 mL hypertonic saline can be given in the same way as above until symptoms get better.

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