A 3-year-old presents with seizures. Serum sodium is 116 mEq/L. He was receiving only free water feeds for 5 days for gastroenteritis. What is the SAFEST rate of sodium correction?
- A Correct at 1–2 mEq/L/hour until sodium reaches 120 mEq/L, then correct slowly
- B Correct at 0.5 mEq/L/hour continuously over 48 hours
- C Give 3% NaCl 2 mL/kg IV over 10 minutes to abort seizures; then correct slowly ✓
- D Correct at 2 mEq/L/hour using isotonic saline over 24 hours
Explanation
Acute hyponatremic seizures require immediate treatment with 3% hypertonic saline at 2–3 mL/kg IV bolus (may repeat) to raise serum sodium by 3–5 mEq/L rapidly and stop seizures. After seizing is controlled, correction must not exceed 10–12 mEq/L per 24 hours (or 0.5 mEq/L/hour) to prevent osmotic demyelination syndrome (central pontine myelinolysis), though this is less common in acute hyponatremia than in chronic. Correcting at 1–2 mEq/L/hour beyond the seizure-terminating phase risks overcorrection. Isotonic saline alone will not rapidly correct severe symptomatic hyponatremia. Free-water excess in a child (tea/water gastroenteritis management) is a common cause of hypotonic hyponatremia in India.
Reference: Ghai Essential Pediatrics, 10th ed.
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