What strategies do you use to prevent overcorrection of serum sodium in patients with severe hyponatremia and adrenal insufficiency when initiating glucocorticoid therapy?

How do you approach glucocorticoid replacement in patients with severe hyponatremia due to adrenal insufficiency?

• Start steroid replacement and monitor Na q6-8hrs for signs of overcorrection
• Start steroid replacement and monitor Na, urine osm, urine output q6-8hrs for overdiuresis and brisk Na overcorrection
• Start steroid replacement along with IV D5W or DDAVP to avoid overcorrection
• I do not have enough experience with in-hospital sodium management in this scenario
• Other