Match the hyponatremia level to its recommended treatment.

• A. >125: Water restriction; <125: 3% hypertonic saline; <120: Normal saline with furosemide
• B. >125: Normal saline with furosemide; <125: Water restriction; <120: 3% hypertonic saline
• C. >125: Water restriction; <125: Normal saline with furosemide; <120: 3% hypertonic saline
• D. >125: Water restriction; <125: Hypertonic saline; <120: Normal saline

Answer: (C)

Managing hyponatremia hinges on how low the sodium is and whether the patient has symptoms. The goal is to raise the sodium gradually to avoid brain injury from too rapid correction.

When sodium is just above 125 mEq/L, simply restricting water intake can prevent further dilution and is often sufficient for mild cases.

If the sodium falls below 125, the approach shifts to restoring volume and promoting free-water excretion. Normal saline helps address any volume deficit while a loop diuretic like furosemide accelerates water loss, which helps raise the serum sodium safely.

If sodium drops below 120, especially with signs of significant symptoms, a more aggressive correction is needed using hypertonic saline (3% saline). This can rapidly increase the sodium to relieve dangerous cerebral edema, but it requires close monitoring to avoid overshoot and osmotic demyelination.

In short: >125 = water restriction; <125 = normal saline with furosemide; <120 = 3% hypertonic saline, with careful monitoring throughout to control the rate of correction.