Introduction to Clinical Medicine III (ICM3) Exam 1 Practice

Osmotic demyelination happens when hyponatremia is corrected too quickly, so the goal is to restore the sodium level gradually rather than with rapid shifts. The safest strategy is to limit free water intake with fluid restriction and use hypertonic saline only if there are life‑threatening symptoms, doing so in a controlled, stepwise way to keep the rise in serum sodium within safe limits. This cautious approach helps prevent the brain from losing or gaining water too rapidly, which is what drives osmotic demyelination.

Infusing hypertonic saline rapidly would push sodium up quickly and increase the risk of demyelination. Loop diuretics to raise sodium quickly are not a reliable, first‑line solution and can lead to unpredictable changes if not tightly monitored. Giving isotonic saline regardless of volume status can worsen hyponatremia in many etiologies (like SIADH or euvolemic states) and does not address the need to avoid rapid correction.