Scenario
A 38 year old woman presents in a post-ictal state. A venous blood gas on arrival reveals a Sodium level of 110 mmol/L (Reference Range: 135-145 mmol/L).
Question
a. List the possible causes of hyponatraemia in this patient. (30%) b. Outline your management of this patient. (70%)
Answer
FACEM SAQ Exam 2005.2 – Question 3
- The overall pass rate for this question was 47/56 (83.9%).
- Pass Criteria
- Examiners expected that the list of possible causes would be structured such that it made clear both the most likely causes as well as some sort of classification that addressed volume status, urine sodium excertion and urine tonicity.
- The management needed to address routine aspects of post ictal care such as airway and treating hypoglycaemia as well as the specifics of sodium replacement.
- There needed to be recognition that active partial correction of sodium was required in the context of this scenario though subsequent management of acute versus chronic hyponatraemia may be different.
- Features of unsuccessful answers
- Failing answers gave no structure to the list of possible causes and didn’t recognize the serious nature of this presentation with the need for active treatment.
About Mike Cadogan
