Approach to hypernatremia Quiz: Ace Your Exams
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A 45-year-old woman is evaluated in the intensive care unit (ICU) following a traumatic intracranial hemorrhage. The patient was involved in a high-speed motor vehicle accident and sustained a closed head injury with subarachnoid hemorrhage. There is no other significant medical history. Temperature is 37°C (98.6°F), blood pressure is 126/64 mmHg, heart rate is 87 beats per minute, respiratory rate is 16 breaths per minute, and oxygen saturation is 99% on the ventilator. On physical examination, the patient is in no acute distress. Cardiopulmonary and abdominal examinations are unremarkable. Mucous membranes are moist. Laboratory results are detailed below. The patient’s urine osmolality increases by 55% one hour after administration of intravenous (IV) desmopressin. Which of the following is the most likely diagnosis?
| Laboratory value | Result |
| Serum chemistry | |
| Sodium | 151 mEq/L |
| Potassium | 3.9 mEq/L |
| Chloride | 99 mEq/L |
| Urine osmolality | 210 mOsm/kg |
| Plasma osmolality | 330 mOsm/kg |
| Urine output | 64 mL/Kg/24 hours |
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