Na 116 with a seizure and confusion is severe symptomatic hyponatremia (cerebral edema). Regardless of the underlying cause, it is treated acutely with 3% hypertonic saline to raise Na quickly, limiting correction to about 6–8 mEq/L in 24 h to avoid osmotic demyelination.

• Furosemide/valsartan may later address possible heart failure (cardiomegaly), but they do not treat the seizure now.
• Vasopressors are irrelevant.