What is your approach to management of severe hyponatremia in patients with alcohol use disorder who experience seizures that could be secondary to the electrolyte derangement or alcohol withdrawal?

What is your approach to managing seizures in a patient with alcohol use disorder and severe hyponatremia when the etiology of the seizure is unclear?

• I treat empirically for hyponatremia with hypertonic saline if serum sodium is below 120 mEq/L
• I treat empirically for alcohol withdrawal seizures with benzodiazepines regardless of sodium level, given the higher immediate risk of withdrawal
• I treat both simultaneously with hypertonic saline and benzodiazepines given the difficulty of distinguishing the etiology in real time
• I obtain an urgent neurology consultation before initiating specific treatment
• Other