A 72-year-old man with SIADH secondary to small cell lung cancer presents with acute confusion and generalized seizures. Vital signs: BP 128/76 mmHg, HR 92 bpm, RR 18/min, Temp 37.2°C. Serum sodium is 118 mEq/L (osmolality 238 mOsm/kg), urine osmolality 580 mOsm/kg. He has been on fluid restriction for 2 weeks without symptom improvement. Neuroimaging shows no acute intracranial pathology. Which of the following is the most appropriate initial management?
- A)Hypertonic (3%) saline with furosemideGABARITO
- B)Normal saline infusion alone
- C)Free water loading to promote diuresis
- D)Desmopressin to increase ADH levels
- E)Hypertonic saline at rapid infusion rate to correct sodium by 20 mEq/L
Explicação
Symptomatic hyponatremia (seizures, altered mental status) is a medical emergency requiring hypertonic saline. The combination of 3% saline with furosemide promotes sodium repletion while preventing fluid overload and hypervolemia. Initial goal is to raise ser... Ver explicação completa e trilha adaptativa →