Approach to hyponatremia Quiz: Ace Your Exams
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A 30-year-old woman comes to the emergency department for evaluation of weakness and muscle cramps. The patient has intentionally lost 25 lbs (11.3 kg) in the past 3 months. She has a history of obesity and takes no medication. Temperature is 37.0°C (98.6°F), pulse is 105/min, respirations are 16/min, and blood pressure is 100/60 mmHg. BMI is 36 kg/m2. She appears weak, but is able to respond to questions appropriately. Physical examination reveals dry mucous membranes and diminished skin turgor. Her neck appears supple. She has multiple abrasions on her hands. The remainder of the physical examination is unremarkable. Initial laboratory evaluation is shown below. Which of the following is the most likely cause of hyponatremia in this patient?
| Laboratory value | Result | Reference range |
| Serum Chemistry | ||
| Sodium | 125 mEq/L | 136-146 mEq/L |
| Potassium | 3.0 mEq/L | 3.5-5 mEq/L |
| Chloride | 84 mEq/L | 95-105 mEq/L |
| Bicarbonate | 40 mEq/L | 22-28 mEq/L |
| Serum Osmolality | 270 mOsm/kg H2O | 280-295 mOsm/kg H2O |
| Urine Chemistry | ||
| Urine sodium | 15 mEq/L | 20-25 mEq/L |
| Urine chloride | 3 mEq/L | 20-40 mEq/L |
| Urine osmolality | 560 mOsm/kg | 50-1,200 mOsm/kg |
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