Approach to hyponatremia (pediatrics) Quiz: Ace Your Exams

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A 10-year-old boy with a recent diagnosis of a craniopharyngioma is brought to the emergency department by his parents due to altered mental status. He has had no vomiting or diarrhea. On arrival, his temperature is 37°C (98.6°F), pulse is 90/min, respirations are 18/min, and blood pressure is 110/60 mmHg. On physical examination, the patient appears confused, does not know his age, and does not recognize his parents. Cardiopulmonary examination reveals a regular heart rate with no murmurs or gallops. Capillary refill is 2 seconds, and mucous membranes are moist. Lungs are clear bilaterally. The abdomen is soft and non-tender with no organomegaly. Laboratory results are shown below. Which of the following is the most appropriate next step to determine the cause of hyponatremia in this patient?

 Laboratory Value Results Reference Range
 Sodium 126 mEq/L 136-145 mEq/L
 Potassium 3.2 mEq/L 3.8-5.4 mEq/L
 Glucose 95 mg/dL 70-106 mg/dL
 BUN 10 mg/dL 5-17 mg/dL
 Creatinine 0.4 mg/dL 0.2-0.5 mg/dL
 Urine protein Negative Negative
 Urine glucose Negative Negative
 Plasma osmolality 272 mOsm/kg 275-296 mOsm/kg

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