An 8-month-old exclusively breastfed infant presents with severe hyponatremia (Na+ 118 mEq/L), seizures and no signs of dehydration. The mother has been diluting formula with excessive water. The immediate treatment for symptomatic hyponatremia is:
- A Fluid restriction alone
- B Slow infusion of 0.9% normal saline over 24 hours
- C Bolus of 3% hypertonic saline (2–3 mL/kg) to raise Na+ by 5 mEq/L and stop seizures ✓
- D Oral sodium chloride supplementation
Correct answer: C. Bolus of 3% hypertonic saline (2–3 mL/kg) to raise Na+ by 5 mEq/L and stop seizures
Explanation
Symptomatic hyponatremia with seizures requires immediate correction of sodium using 3% hypertonic saline (2–3 mL/kg IV over 15–20 min) to raise serum sodium by approximately 5 mEq/L and terminate seizure activity. This is the emergency intervention. Further correction is then carried out slowly (not >0.5 mEq/L/hour or 10–12 mEq/L/day) to avoid osmotic demyelination syndrome. Fluid restriction is for chronic euvolemic hyponatremia (SIADH), not emergency management.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.