A 60-year-old woman admitted with confusion has serum sodium of 106 mEq/L. She is treated with 3% saline and her sodium rises to 122 mEq/L within 18 hours. Two days later she develops flaccid quadriparesis, dysarthria, and dysphagia. MRI shows a central pontine lesion. Which measure would have BEST prevented this complication?
- A Limiting the rise in serum sodium to 8 to 10 mEq/L in the first 24 hours ✓
- B Restricting total fluid intake to 800 mL per day during correction
- C Administering furosemide along with isotonic saline
- D Correcting the sodium fully before treating the underlying cause
Correct answer: A. Limiting the rise in serum sodium to 8 to 10 mEq/L in the first 24 hours
Explanation
Osmotic demyelination syndrome follows over-rapid correction of chronic hyponatraemia, classically more than 10 to 12 mEq/L in 24 hours. Current practice limits correction to 8 to 10 mEq/L per day, using desmopressin or dextrose water to halt a too rapid rise. Fluid restriction treats the hyponatraemia itself but does not control the rate of rise achieved with hypertonic saline.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.