A 2-year-old child presents with hyponatremic dehydration (serum Na 118 mEq/L) and lethargy. Which of the following is the MOST appropriate initial correction strategy?
- A Rapid correction to normal sodium in 4–6 hours with hypertonic saline
- B Free water restriction only
- C Hypertonic (3%) saline 2–4 mL/kg IV to raise sodium by 4–6 mEq/L only if symptomatic (seizures/coma), then slow correction ✓
- D Normal saline 10 mL/kg bolus followed by D5 0.9% NaCl maintenance
Correct answer: C. Hypertonic (3%) saline 2–4 mL/kg IV to raise sodium by 4–6 mEq/L only if symptomatic (seizures/coma), then slow correction
Explanation
In symptomatic hyponatremia (Na <120 mEq/L with neurological symptoms), hypertonic 3% saline at 2–4 mL/kg is given to acutely raise serum sodium by 4–6 mEq/L and stop seizures or impending herniation. After acute stabilization, correction should proceed at no more than 10–12 mEq/L per 24 hours to prevent osmotic demyelination syndrome (central pontine myelinolysis). Rapid full correction is dangerous.
Reference: Ghai Essential Pediatrics, 10th ed.
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