What should be avoided to prevent over-correction of serum sodium levels?

Using vaptans in combination with hypertonic saline should be avoided to prevent the over-correction of serum sodium levels. Vaptans are a class of medications known as vasopressin receptor antagonists, which promote the excretion of free water in the urine, thereby raising serum sodium levels. When used alongside hypertonic saline, which is designed to directly increase serum sodium concentration, there is a significant risk of causing rapid shifts in sodium levels. This can lead to osmotic demyelination syndrome, a serious condition that results from overly rapid correction of hyponatremia, where sodium levels rise too quickly, causing neurological damage.

To manage hyponatremia safely, a gradual correction is essential. It is typically recommended to limit the rate of increase in serum sodium to prevent complications associated with rapid changes. Therefore, the simultaneous use of vaptans and hypertonic saline can inadvertently lead to too swift an increase in sodium, making this approach particularly risky.

The other choices do not have the same significant risk of causing over-correction of serum sodium levels. Isotonic saline typically maintains fluid balance without rapidly altering sodium levels, while administering diuretics and restricting fluid intake, although they may alter fluid and electrolyte balance,