A fictional 39-year-old taking a thiazide has vomiting, confusion and a generalised seizure; serum sodium is profoundly low.
Frame the danger first.
- Judge urgency from neurological symptoms and acuity as well as the sodium concentration.
- Consider medicines, excess water intake, volume status, adrenal insufficiency, hyperglycaemia and organ failure.
- Seizure, reduced consciousness and cardiorespiratory compromise indicate a medical emergency.
Act, escalate, reassess.
- Call for senior, endocrine and critical-care help and follow the current local severe-hyponatraemia protocol.
- Treat severe neurological symptoms with monitored protocol-directed therapy and predefined early correction targets.
- Measure sodium frequently, document fluid balance and be ready to prevent or reverse excessive correction.
- Investigate the cause after immediate stabilisation without delaying emergency treatment.
Red flags that change pace.
- Seizure, coma, respiratory compromise or rapidly worsening confusion
- Very acute onset, pregnancy or intracranial disease
- Sodium rising faster than the protocol limit or unexpectedly large urine output
What makes care less safe.
- Treating the laboratory number without considering symptoms and timing
- Continuing correction without frequent sodium checks
- Failing to plan for overcorrection after removing the cause of water retention
Say the concern plainly.
Severe symptomatic hyponatraemia with sodium [result/trend], neurological features [summary] and likely duration/cause [summary]. Protocol treatment started at [time]; correction is [rate]. I need immediate endocrine/critical-care oversight.