Approach to hyponatremia (pediatrics) Quiz: Ace Your Exams

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A 14-year-old girl presents is brought to the clinic by her parents who have noticed excessive drinking of water and an increased frequency of urination for 2 months. Symptoms started gradually but have progressively worsened. There is no history of edema, polyphagia, fever, head trauma, chronic cough, recent weight gain or loss, or seizures prior to onset of symptoms. She uses lithium for treatment of bipolar disorder. Past surgical and family history are non-contributory. Temperature is 37°C (98.6°F), pulse is 100/min, respirations are 20/min, and blood pressure is 100/65 mm Hg. Physical exam reveals moist mucous membranes and capillary refill is 2 seconds. Cardiopulmonary exam is normal. Abdomen is soft and non-tender with no hepatomegaly. Lab results are shown below. Which of the following should be done next to confirm the diagnosis?

 Laboratory Value Result Reference Range
 Serum sodium 149 mEq/L 136-145 mEq/L
 Serum Potassium 3.5 mEq/L 3.85.4 mEq/L
 Serum Calcium 9.2 mg/dL 8.5-10.6 mg/dL
 Serum Osmolality 370 mOsm/kg 275-296 mOsm/kg
 Blood urea nitrogen (BUN) 15 mg/dL 7-18 mg/dL
 Creatinine 0.5 mg/dL 0.3-0.8 mg/dL
 Random blood glucose 74 mg/dL 70-106 mg/dL
 Urine specific gravity 1005 1003-1.035
 Urine Osmolality 100 mOsm/kg 50-1,500 mOsm/kg

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