رجل عمره ٦٦ سنة مدخن عنده سرطان رئة. صار مشوشاً ومتعباً، ووزنه زاد قليلاً بدون تورم، وبوله قليل ومركز. الصوديوم ١١٨، وأسمولية البول مرتفعة، والضغط ١٣٢/٨٠. حدثت له نوبة تشنج قصيرة. ما الأولوية؟

A 66-year-old smoker with lung cancer has become confused and tired, has gained slight weight without oedema and passes small amounts of concentrated urine. Sodium 118, high urine osmolality, BP 132/80. He has had a brief seizure. What is the priority?

1. Give large volumes of dilute IV fluids
2. Raise sodium rapidly to normal within hours
3. Encourage plenty of water by mouth to flush the kidneys
4. Correct sodium slowly as ordered with seizure precautions

Answer: D) Correct sodium slowly as ordered with seizure precautions. SIADH causes hyponatraemia with water retention. With seizures, hypertonic saline is given cautiously, but rapid correction risks osmotic demyelination, so the daily rise is limited; fluids are restricted.