The patient’s head CT is normal without evidence of intracranial hemorrhage, extracerebral fluid collection, midline shift or mass effect. There is some artifact from patient motion.

The patient has no prior laboratory results for comparison.

This patient is hemodynamically stable, and her seizure is most likely driven by her low serum sodium. Given the likely etiology, normal saline may actually worsen her hyponatremia here. Try again!

Correct! We need to rapidly correct this patient’s hyponatremia, as this is the most likely cause of her seizure. This bolus would be expected to raise her serum sodium by approximately 1-2mEq, hopefully enough to get her out of danger.

This patient’s seizure is likely due to an electrolyte abnormality which needs rapid correction. Try again!

While this is an appropriate medication choice, this drip will likely not be enough to correct her electrolyte abnormality quickly. Try again!

While it may be helpful to repeat head imaging once the patient has stabilized, this is not the best first step. Try again!

Elevated triglyceride levels and paraprotein levels can falsely elevate the sodium laboratory result if the indirect potentiometry is utilized. The patient’s symptomatic hyponatremia makes pseudohyponatremia less likely, making these tests less helpful here.

Excellent! More on these results below.

Good choice! The serum osmolality (drawn prior to administration of hypertonic saline) is 242 mosm/kg. 

Great! The uric acid level is below the lower limit of normal.

Hyperglycemia can lead to hypertonic hyponatremia. We already have a normal glucose value, making this etiology unlikely.

Though this patient seems to have ingested a substance, methanol is less likely given the absence of an anion gap metabolic acidosis.