Approach to hyponatremia (pediatrics) Quiz: Ace Your Exams

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An 18-month-old boy is brought to the emergency department with fevers, diarrhea, vomiting, and decreased oral intake for three days. He has been less playful and has had fewer wet diapers than usual. Temperature is 38°C (100.4°F), pulse is 133/min, respirations are 22/min, and blood pressure is 88/52 mmHg. On physical examination, the patient looks sick with sunken eyes. Mucous membranes are dry, and capillary refill is 4 seconds. The patient is tachycardic but has no murmur or gallops. Chest and abdominal exams are normal. Initial lab work is shown below. Which of the following additional lab results would confirm the most likely cause of hyponatremia in this patient?

Laboratory value	Results
pH	7.27
pCO₂	45 mmHg
HCO₃-	17 mEq/L
Base deficit	-5
Serum sodium	126 mEq/L
Random blood glucose	92 mg/dL

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Urine osmolality of 500 mOsm/kg

Urine sodium of 10 mEq/L

Urine sodium of 27 mmol/L

Serum osmolality of 350 mOsm/kg

Serum potassium of 5.4 mEq/L