A physician-validated, board-style question from the Active Transport QBank. Try it, then check the reasoning for every option.
A 70-year-old man with a history of congestive heart failure is admitted with worsening shortness of breath and edema. He is found to have hyponatremia with a serum sodium of 122 mEq/L. On examination, his blood pressure is 110/70 mmHg, pulse is 95/min, and he has jugular venous distension. Which fluid therapy strategy is most appropriate to safely correct his sodium imbalance?
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A
Isotonic saline infusionIncorrect. Isotonic saline alone in CHF would worsen fluid overload and not correct the dilutional hyponatremia.
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B
Fluid restriction onlyIncorrect. Fluid restriction alone is too slow and inadequate for symptomatic CHF with hyponatremia and JVD.
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C
Loop diuretics with isotonic salineCorrect. Loop diuretics with isotonic saline remove free water while replacing sodium, safely correcting dilutional hyponatremia.
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D
Dextrose 5% water infusionIncorrect. D5W is free water and would worsen hyponatremia by further dilution.
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E
Hypertonic saline infusionIncorrect. Hypertonic saline risks osmotic demyelination in chronic hyponatremia and is reserved for severe symptomatic cases.
↑ Tap an answer to reveal the reasoning
Answer: C. The patient has dilutional hyponatremia secondary to congestive heart failure. The best strategy is to use loop diuretics to remove excess fluid while providing isotonic saline to prevent further sodium dilution. Hypertonic saline is inappropriate due to risk of osmotic demyelination syndrome, and fluid restriction alone would not suffice given the volume overload.