4.5 of 13 Ratings
A 69-year-old male presents to the emergency department for slurred speech and an inability to use his right arm which occurred while he was eating dinner. The patient arrived at the emergency department within one hour. A CT scan was performed of the head and did not reveal any signs of hemorrhage. The patient is given thrombolytics and is then managed on the neurology floor. Three days later, the patient is recovering and is stable. He seems depressed but is doing well with his symptoms gradually improving as compared to his initial presentation. The patient complains of neck pain that has worsened slowly over the past few days for which he is being given ibuprofen. Laboratory values are ordered and return as indicated below:Serum:Na+: 130 mEq/LK+: 3.7 mEq/LCl-: 100 mEq/LHCO3-: 24 mEq/LUrea nitrogen: 7 mg/dLGlucose: 70 mg/dLCreatinine: 0.9 mg/dLCa2+: 9.7 mg/dLUrine:Appearance: darkGlucose: negativeWBC: 0/hpfBacterial: noneNa+: 320 mEq/L/24 hoursHis temperature is 99.5°F (37.5°C), pulse is 95/min, blood pressure is 129/70 mmHg, respirations are 10/min, and oxygen saturation is 98% on room air. Which of the following is the best next step in management?
Oral salt tablets
Continue conservative management
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A 39-year-old female presents with confusion. Her husband reports that she doesn't know where she is and cannot remember the date. She was recently diagnosed with small cell lung cancer. Vital signs are T 37C, HR 80, BP 120/80 mmHg, RR 14, and O2 sat 99% on room air. She is not orthostatic. Physical examination reveals moist mucous membranes and normal capillary refill. A basic metabolic profile reveals that serum sodium is 129. Regarding this patient's illness, which of the following is true?
Urinary osmolarity will be > 100, and this illness will not correct with saline infusion
Urinary osmolarity will be < 100, and another potential cause of this disorder is excessive water drinking
Urinary sodium will be > 20 and fractional excretion of sodium will be >1%
Urinary sodium will be < 10, and fractional excretion of sodium will be <1%
Urinary sodium will be > 20 and another potential cause of this disorder is renal failure