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Category: Critical Care Medicine-Renal, Electrolyte and Acid Base Disorders--->Sodium
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Question 6#Print Question

A 68-year-old male with long-standing smoking and alcohol use history presents to his primary care physician. His wife noticed progressively worsening jaundice and poor appetite with an associated weight loss of 35 lbs over the past 2 months. He also reports early satiety and vague abdominal pain. 

His temperature is 37.5°C, blood pressure is 110/75 mm Hg, pulse rate is 84 beats/min, and respiratory rate is 12 breaths/min. An ultrasound of his abdomen confirms a mass in the head of the pancreas. He is admitted for surgical intervention, and laboratory data obtained show the following:

  • Sodium 131 mEq/L (mmol/L)
  • Potassium 3.8 mEq/L (mmol/L)
  • BUN 7 mg/dL
  • Creatinine 1.0 mg/dL
  • Total bilirubin 8.7 mg/dL
  • Amylase 90 U/L
  • Lipase 67 U/L
  • Total cholestrol 485 mg/dL
  • LDL cholesterol 157 mg/dL
  • HDL cholesterol 42 mg/dL
  • Triglycerides 349 mg/dL
  • Plasma osmolality 295 mOsm/kg
  • rine osmolality 420 mOsm/kg
  • TSH 2.1 mIU/L
  • Glucose 93 mg/dL

What is the MOST likely cause for the patient’s hyponatremia?

A. Beer potomania
B. Psychogenic polydipsia
C. SIADH
D. Adrenal insufficiency
E. Pseudohyponatremia


Question 7#Print Question
  • A 24-year-old woman is brought to the emergency department by her boyfriend for worsening lethargy. He reports that she has no known medical history and was doing well until 2 days ago after they returned home from a hiking trip on the Appalachian trail. She started experiencing diarrhea after drinking from the fresh springs. Vital signs are as follows:
  • temperature is 37.8°C
  • blood pressure is 97/64 mm Hg
  • pulse rate is 112 beats/min
  • respiratory rate is 14 breaths/min

On physical examination, abdominal examination reveals tenderness in the left lower quadrant and weak radial pulses.

Lab. results:

  • Sodium 144 mEq/L (mmol/L)
  • Potassium 3.9 mEq/L (mmol/L)
  • Chloride 110 (mmol/L)
  • Bicarbonate 18 (mmol/L)
  • BUN 42 mg/dL
  • Creatinine 1.2 mg/dL
  • Glucose 123 mg/dL
  • Urine sodium 24 mEq/L

What is the next BEST step in management of this patient’s condition?

 

A. Normal saline with 20 KCl mEq/L
B. Ringer lactate
C. ½ normal saline
D. ½ normal saline with D5W
E. Normal saline with D5W


Question 8#Print Question

A 38-year-old male is brought to the hospital after a witnessed seizure. The patient’s medical history is only significant for bipolar disease. His sister also reports that he recently started a new diet regimen using herbal supplements that he purchased online. On physical examination, his vital signs are unremarkable. He appears unkempt, and there is a small laceration noted over his tongue. His serum sodium is 128 mEq/L (mmol/L). Other laboratory findings before and after water deprivation test (WDT) are shown below: 

What is the MOST likely diagnosis in this patient?

A. Nephrogenic DI
B. Pseudohyponatremia
C. Psychogenic polydipsia
D. SIADH
E. Central DI


Question 9#Print Question

A 19-year-old woman with past medical history of type I diabetes mellitus and seizures on oxcarbazepine is admitted for fever, chills, and myalgia. She works as a nurse assistant in the local skilled nursing facility where a few patients recently have been diagnosed with the flu. Her appetite has been poor since her symptoms started, and she also reports bouts of diarrhea. On physical examination, she is febrile with a temperature of 38.7°C, blood pressure is 102/76 mm Hg, pulse rate is 120 beats/min, and respiratory rate is 12 breaths/min. Laboratory values show the following:

  • Sodium 130 mEq/L (mmol/L)
  • Potassium 4.1 mEq/L (mmol/L)
  • Chloride 95 (mmol/L)
  • Bicarbonate 9 (mmol/L)
  • BUN 9 mg/dL
  • Creatinine 0.7 mg/dL
  • Glucose 623 mg/dL 

What is the MOST likely underlying cause for her hyponatremia?

A. Poor solute intake
B. SIADH
C. Medication related
D. Hyperglycemia
E. Diarrhea


Question 10#Print Question

A 56-year-old man with a past medical history of hypertension, hyperlipidemia, and type II diabetes mellitus presents to his primary care physician for a follow-up visit. He started working as a welder 6 months ago and was recently diagnosed with hypersensitivity pneumonitis after complaining of worsening shortness of breath at the time. He was prescribed a medication whose name he is unable to recall but stopped taking them abruptly after 2 months because of his busy schedule. His other medications include amlodipine, atorvastatin, and hydrochlorothiazide though he admits being noncompliant with those, too.

Today, he reports fatigue, unintentional weight loss of 7 lbs in 2 weeks, nausea, and lightheadedness.

Pertinent vital signs include a temperature of 37.6°C, blood pressure of 117/58 mm Hg, pulse rate of 92 beats/min, and respiratory rate of 12 breaths/min.

What are the MOST likely laboratory findings in this patient?

A. A
B. B
C. C
D. D
E. E




Category: Critical Care Medicine-Renal, Electrolyte and Acid Base Disorders--->Sodium
Page: 2 of 2