Correct!
4. 1 and 3
The most likely cause of his bradycardia is the beta blocker. This was held and his symptomatic bradycardia resolves over several hours. His hyponatremia should not be rapidly corrected because rapid correction can result in osmotic demyelination syndrome (ODS) (2). His hyponatremia should be corrected slowly at 4-8 mEq/L per day. Vasopressin receptor antagonists (vaptans) should not be used in hypovolemic hyponatremia, or in conjunction with other treatments for hyponatremia (2). One could administer limited amounts of 3% saline with careful monitoring of his serum sodium but that is not given as one of the options.
He is monitored in the intensive care unit and his serum sodium slowly rises. However, over several days his platelet count slowly decreased (Figure 1).
Figure 1. Platelet count over initial days of hospital admission.
Accompanying the decrease in platelets was an increase in the white blood cell count to over 30,000 cells/mm3.
What should be done at this time? (Click on the correct answer to be directed to the fourth of six pages)