GP Vivas · kidney-and-urinary-health
Hyponatraemia in adults — structured viva
Structured oral on hyponatraemia: prevalence and the mild-disease burden, thiazide risk quantified, volume-status-based diagnosis with SIAD mimics, fluid restriction evidence, tolvaptan and urea comparisons, the correction-rate controversy, and severe symptomatic management.
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Target exams
RACGP CCEFRACGP oralsMRCGP SCA
Prompt
The examiner opens: 'Sodium of 126 mmol/L in a 70-year-old woman. Take me through it.' The viva branches through severity triage, diagnosis by volume status, drug causes with numbers, SIAD treatment options with trial evidence, and the correction-rate tightrope.
Stem
The number is 126. The woman is in front of you. The next 48 hours of decisions determine whether this ends in recovery, a fall, or an osmotic demyelination referral letter. [2]
References10ShowHide
- [2]Adrogué HJ, Tucker BM, Madias NE Diagnosis and Management of Hyponatremia: A Review. JAMA, 2022.PMID 35852524
- [4]Andersson NW, Wohlfahrt J, Feenstra B et al. Cumulative Incidence of Thiazide-Induced Hyponatremia : A Population-Based Cohort Study. Annals of internal medicine, 2024.PMID 38109740
- [5]Kawahara T, Toda M, Kanagawa M et al. Etiology and Clinical Features of Patients With Hyponatremia in the Emergency Department: A Cross-sectional Study. The Journal of clinical endocrinology and metabolism, 2025.PMID 40130271
- [7]Beck J Treatment of chronic hyponatremia and controversy about osmotic demyelination syndrome. Best practice & research. Clinical endocrinology & metabolism, 2026.PMID 41219109
- [1]Garrahy A, Galloway I, Hannon AM et al. Fluid Restriction Therapy for Chronic SIAD; Results of a Prospective Randomized Controlled Trial. The Journal of clinical endocrinology and metabolism, 2020.PMID 32879954
- [6]Warren AM, Grossmann M, Hoermann R et al. Tolvaptan vs Fluid Restriction in Moderate-Profound Hyponatremia: An Open-Label Randomized Clinical Trial. The Journal of clinical endocrinology and metabolism, 2026.PMID 40720585
- [10]Heller M, Marx K, Hoffmann U et al. Urea vs. tolvaptan for hospitalized patients with SIADH. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2026.PMID 42455009
- [3]Krisanapan P, Tangpanithandee S, Thongprayoon C et al. Safety and Efficacy of Vaptans in the Treatment of Hyponatremia from Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH): A Systematic Review and Meta-Analysis. Journal of clinical medicine, 2023.PMID 37685548
- [8]Schneider AR, Radu LM, Tang KL Outcomes with Sodium Overcorrection in Chronic Hyponatremia: A Systematic Review and Meta-analysis. Journal of general internal medicine, 2026.PMID 41652262
- [9]Matrisch L, Rau Y, Graßhoff L et al. On the optimal sodium correction rate in hyponatraemia and clinical outcome: a meta-analysis. Emergency medicine journal : EMJ, 2026.PMID 42097878