American Board of Internal Medicine (ABIM) Certification Practice Exam

How should overcorrection of chronic asymptomatic hyponatremia be managed?

1. With oral sodium chloride

2. Using desmopressin with 5% dextrose

3. By administering intravenous fluids

4. Through slow tapering of vasopressin antagonists

The correct answer is: Using desmopressin with 5% dextrose

In the context of managing overcorrection of chronic asymptomatic hyponatremia, the appropriate management involves a careful and controlled approach to correct any resultant hypernatremia, preventing complications such as osmotic demyelination syndrome. Using desmopressin with 5% dextrose can effectively help in managing this condition. Desmopressin acts as a vasopressin analogue and can assist in decreasing urinary output and promoting rehydration. This is particularly beneficial when hypernatremia arises after overshooting the correction of sodium levels, as it helps to stabilize the osmotic environment by adjusting fluid balance and promoting gradual sodium normalization. The addition of dextrose allows for careful rehydration without increasing osmolarity too rapidly. This approach prevents further complications and manages the sodium levels effectively. The choice of using desmopressin with dextrose specifically addresses the need for a safe and controlled correction while considering the risk factors associated with overly aggressive treatment of electrolyte imbalances.