Approach to hypernatremia (pediatrics) Quiz: Ace Your Exams

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A 12-year-old girl presents to the office for dizziness, weakness, numbness and tingling in her hands and feet and headaches for 3 months. She reports feeling fatigued and has been noticing palpitations for the last week. There is no history of fever, peripheral edema, polyphagia, vomiting, or diarrhea. She does not use any medication. She has no significant surgeries. There is no family history of hypertension or renal disease. Temperature is 37°C (98.6°F), pulse is 70/min, and respirations are 18/min. Cardiopulmonary exam is normal. The abdomen is soft and nontender. Lab results are shown below. Which of the following additional findings is most likely to be seen given the likely diagnosis? 

 Laboratory value     Result     
 Hemoglobin      12.5 g/dL    
 Serum sodium     148 mEq/L    
 Serum Potassium      2.5 mEq/L    
 Serum osmolality      295 mOsm/kg    
 PH     7.48    
 PCO2     40 mmHg    
 Bicarbonate     28 mEq/L    
 Blood urea nitrogen (BUN)     10 mg/dL    
 Creatinine      0.4 mg/dL    
 Urine sodium     20 mEq/L    
 Urine creatinine      230 mg/dL    
 Urine osmolality      350 mOsm/kg     
 Fractional excretion of sodium (FENa)     1%    
 

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