Diabetes insipidus Quiz: Ace Your Exams

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A 30-year-old woman presents to the clinic for evaluation of severe thirst and production of large volumes of urine over the past month. She has bipolar disorder and has been on lithium therapy for several years. Vital signs are unremarkable. On physical examination her mucus membranes appear dry; the exam is otherwise unremarkable. A point-of-care glucose check is 88 mg/dL. The physician suspects the patient’s condition is likely caused by lithium and orders an initial set of laboratory studies to evaluate. Which of the following sets of laboratory results would best support their suspicion?

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Laboratory study	Result
Serum sodium	150 mEq/L
Serum osmolality	310 mOsm/kg
Urine osmolality (baseline)	700 mOsm/kg

Laboratory study	Result
Serum sodium	150 mEq/L
Serum osmolality	310 mOsm/kg
Urine osmolality (baseline)	150 mOsm/kg

Laboratory study	Result
Serum sodium	126 mEq/L
Serum osmolality	270 mOsm/kg
Urine osmolality (baseline)	100 mOsm/kg

Laboratory study	Result
Serum sodium	125 mEq/L
Serum osmolality	265 mOsm/kg
Urine osmolality (baseline)	500 mOsm/kg

Laboratory study	Result
Serum sodium	128 mEq/L
Serum osmolality	320 mOsm/kg
Urine osmolality (baseline)	800 mOsm/kg