07-29-2015, 06:47 PM
A 36-year-old woman presents to the ED after experiencing a seizure in her apartment 3 hours earlier. She has no known prior medical problems, and takes only aspirin for some recent headaches. She is currently lethargic but responsive and coherent. Her temperature is 37.2°C (98.9°F), blood pressure is 117/68 mm Hg with no orthostatic changes, and pulse is 70/min. Physical examination reveals anicteric sclerae with reactive pupils and moist mucous membranes.
Laboratory tests show:
Na+ 124 mEq/L
Ca2+ 9.8 mg/dL
Cl− 100 mEq/L
HCO3 − 19 mEq/L
Blood urea nitrogen 9.2 mg/dL
Creatinine 0.9 mg/dL
Glucose 110 mg/dL
Liver function tests, amylase, lipase, and bilirubin are normal. Urine electrolytes reveal an elevated urine sodium. Which of the following is the most likely cause of this patient’s hyponatremia?
(A) Bartter’s syndrome
(B) Brain tumor
© Hyperglycemic crisis
(D) Primary biliary cirrhosis
(E) Subarachnoid hemorrhage
Laboratory tests show:
Na+ 124 mEq/L
Ca2+ 9.8 mg/dL
Cl− 100 mEq/L
HCO3 − 19 mEq/L
Blood urea nitrogen 9.2 mg/dL
Creatinine 0.9 mg/dL
Glucose 110 mg/dL
Liver function tests, amylase, lipase, and bilirubin are normal. Urine electrolytes reveal an elevated urine sodium. Which of the following is the most likely cause of this patient’s hyponatremia?
(A) Bartter’s syndrome
(B) Brain tumor
© Hyperglycemic crisis
(D) Primary biliary cirrhosis
(E) Subarachnoid hemorrhage