Approach to hyponatremia Quiz: Ace Your Exams

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A 65-year-old man comes to the clinic for evaluation of lower back pain. Review of systems is significant for poor appetite and a 10 lbs (4.5 kg) weight loss over the past 6 months. The patient had a resection of a localized meningioma 2 years ago without complications or recurrence. The patient does not take any medication. Vitals are within normal limits. Physical examination shows moist mucous membranes, pallor, and midline tenderness upon palpation at L3 and L4. There is pitting edema in both lower extremities up to the knees. Cardiopulmonary examination is unremarkable without jugular venous distension (JVD). Laboratory results are shown below. A urine dipstick is negative for proteinuria. Radiograph of the spine shows a lytic bone lesion in the L4 vertebral body. Which of the following is the most likely cause of hyponatremia in this patient?  

Laboratory value  
Result
Serum Chemistry   

Sodium
128 mEq/L
Potassium
3.7 mEq/L  
Chloride
100 mEq/L  
Bicarbonate
25 mEq/L  
Calcium
11 mg/dL  
Blood urea nitrogen  
20 mg/dL  
Creatinine
1.2 mg/dL  
Total protein  
8.5 g/dL  
Albumin
2.5 g/dL  
Serum Osmolality  
285 mOsm/kg  
Complete Blood Count   

Hemoglobin
8.0 g/dL  
Leukocyte count  
10,000/mm3   
Platelets
180,000/mm3   
Urine electrolytes   

Sodium
18 mEq/L  

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