A college student participates in a drinking contest and becomes lethargic and disoriented several hours later. Which evaluative judgment about the most likely mechanism and appropriate immediate clinical priority is best?

• A. Conclude the symptoms are certainly due to alcohol poisoning only and manage by keeping the student awake and giving them more water to flush the alcohol, because hyponatremia never occurs outside of marathon runners
• B. Suspect acute water intoxication producing dilutional hyponatremia and cerebral edema; immediate priority is urgent medical evaluation (e.g., emergency department) because the appropriate treatment (often hypertonic saline) must be administered under controlled conditions to prevent progression to coma
• C. Assume the student is experiencing normal fatigue from sleep deprivation and advise rest and caffeine rather than medical evaluation because drinking large volumes of water cannot produce dangerous electrolyte imbalances in young adults
• D. Attribute the symptoms to hypokalemia caused by overdrinking and treat immediately with high-dose oral potassium supplements, which will reverse the neurologic effects within minutes

Answer: (B)